Type of fluid required

• Resusitation fluid
  • 0.9% saline
  • There is no evidence to support the use of colloids or volume expanders in preference to crystalloids
  • There is evidence that rapid reduction in plasma osmolality increase risk of cerebral oedema[33] & hence, 0.45% saline should NOT be used in initial therapy

• Initial intravenous therapy
  • 0.9% saline with 20mmol potassium in 500ml now continues throughout treatment
  • When blood sugar is less than 14mmol/L OR if it drops more than 5mmol/L/hour glucose is added

NB: the insulin infusion is also adjusted (see next section)

• When blood sugar <14 MMOL/L
  • 0.9% saline & 5% glucose with 20mmol KCl in 500ml

• If blood sugar <6MMOL/L
  • 0.9% saline & 10% glucose with 20mmol KCl in 500ml
    • Do not stop the insulin infusion

• If blood sugar <4MMOL/L
  • Give a 2ml/kg bolus of 10% glucose
  • Temporarily pause the insulin infusion for 1 hour.

NB: greater ketosis indicates a need for more insulin hence, higher concentrations of glucose are required to prevent hypoglycaemia