Key Learning Points

Diagnosis of DKA is:
- Blood glucose >11 mmol/l
- pH < 7.3 or bicarbonate <15 mmol/L
- Blood ketones >3mmol/L
All children with DKA should receive a fluid bolus, the rate of which should be based on whether they are clinically shocked or not.
The severity of DKA is based upon the degree of acidosis and can be categorised as mild, moderate and severe.
Each category is associated with an assumed dehydration fluid deficit and this must be replaced along with the required maintenance fluids, over 48 hours.
Replacement fluid is : 0.9% Saline with 20mmol KCL in 500ml.
Insulin at a rate of 0.05units/kg/hour ( or 1 unit/kg/hour if severe DKA or adolescent) should be started at least 1 hour after starting fluid replacement therapy.
As glucose levels drop, glucose will need to be added the fluid.
Risk factors for cerebral oedema include young age, new onset T1DM, longer duration of symptoms, severe acidosis & bicarbonate correction.
Suspected cerebral oedema should be treated with hypertonic saline.
Patients will need regular observations and repeat blood tests whilst they are on they are being treated for DKA.