Type of fluid required

Resuscitation Fluid

• 0.9% salin

Intravenous Fluid Therapy

All fluids, except any initial blouses should contain Potassium Chloride (unless there is evidence of renal failure).

Every 500ml of 0.9% Saline should have 20mmol potassium chloride (40mmol in 1L).

The average child in DKA is depleted in total body potassium irrespective of plasma level [29] and average losses are 3-6mmol/kg. [28-33] In addition, once insulin is started potassium will be driven into the intracellular compartment and plasma levels with decline rapidly. [31]

If at presentation, the Potassium is elevated, Potassium should only be added to the fluids after the patient has passed urine or gives a history of having recently passed urine to ensure they are not anuric; or after the Potassium has fallen to the normal range, which generally occurs after the first fluid bolus.

If the Potassium is <3, then the patient should be discussed with critical care as central access will be required for higher concentration Potassium replacement.

When glucose levels drop…

With the continued intravenous fluid therapy, patients will receive concurrent insulin therapy (see next section). This will drop their glucose level and the type of fluid given is therefore changed.

• When blood sugar <14 mmol/l give: 0.9% saline & 5% glucose with 20mmol KCl in 500ml
• When blood sugar <6 mmol/l give: 0.9% saline & 10% glucose with 20mmol KCl in 500ml

Do not stop the insulin infusion

If blood glucose levels fall below <4 mmol/l:

• Give: bolus of 2ml/kg 10% dextrose
• Give: 0.9% saline & 10% glucose with 20mmol KCl in 500ml

Reduce: insulin rate to 0.05 units/kg/hour. If already running at this rate, consider temporarily reducing this further.