Diabetic ketoacidosis is characterized by hyperglycemia, acidosis and dehydration

If properly managed, children with DKA do very well and can recover within a few hours.

CORRECT DEHYDRATION: Starting with a bolus normal saline 10mL/kg over two hours is usually sufficient in most instances while you are waiting for your metabolic panel results. Then 1.5 to 2 times the maintenance will be the norm. I prefer 1/2 normal saline with KCl 20 mEq/liter in most instances.

START INSULIN: in all cases, NO BOLUS of insulin is needed; an infusion of 0.05 units to 0.1unit/kg/hour will be sufficient. Monitor blood sugars every couple of hours and titrate so that the blood sugars decline gradually.

ADD DEXTROSE: Once the blood sugar reaches 250-200 mg/dL, it is time that you add dextrose to the fluids as you want the child to stop utilizing fat for energy (resulting in the accumulation of ketones) and instead get the energy from the carbohydrates. The insulin will facilitate that as well as correct the acidosis.

MONITOR SODIUM and POTASSIUM: Provide more of these electrolytes as needed. If the serum sodium is high, correct it slowly.; bring it down safely by 0.5 to 1 meq/L each hour.

LOGIC: Act logically in DKA management. Being patient and observant is very important in the safe recovery of the child, avoiding complications like cerebral edema.


Diabetic Ketoacidosis in Infants, Children, and Adolescents. A consensus statement from the American Diabetes Association.