DKA

What is the fluid bolus rate in DKA?

10-20 ml/kg NS over 1 hour may be repeated once

Also allowed over 5-20 minutes if patient is in shock

What is the goal glucose level to maintain in DKA?

200-300 mg/dL

What is one precaution to consider when administering insulin in DKA?

Insulin infusions in hypokalemic patients may worsen hypokalemia

What is the concentration and rate of insulin required for an infusion in DKA?

concentration: 1 unit/ml
rate: 0.1 unit/kg/hour or 0.05 unit/kg/hour if insulin sensitive

What is the fluid rate requirement for patients in DKA?

should not exceed 2 times maintenance fluid from all fluids except insulin

In what situation can we use 0.45% NS?

reserved for patients who are hyperchloremic or hypernatremic

What is the preferred concentration of dextrose for fluid bags in DKA?

10%

What requirements should be met to use D20W?

If patient cannot maintain 180 mg/dL serum glucose under D10W and patient has central line access

What are the requirements for potassium replacement in DKA?

less than or equal to 5.5mmol/L
40mEq/L K = 20mEq/L KCl + 13.6mmol/L KPO4

What conditions call for bicarbonate replacement and at what dose?

If arterial pH less than 7 and impaired cardiac contractility and vascular tone present

Severe hyperkalemia

Dose 0.5 to 1 mEq/kg IV over 60 minutes

What is the treatment protocol for cerebral edema occurring during DKA?

Mannitol: 0.25 to 1 g/kg IV bolus over 20 to 30 minutes

3% Sodium Chloride: 5 to 10 mL/kg IV bolus over 30 minutes