Treatment of DKA requires first and foremost fluid resuscitation with 0.9% saline, followed by replacement for 5%–10% dehydration, depending on severity, and maintenance with 0.45% saline, and early and adequate K replacement.
In this way, how do you calculate fluid deficit in DKA for children?
For most children, use
| Weight | |
|---|---|
| >60kg | 35 ml/kg/24 hrs |
Also know, is creatinine elevated in DKA?
In patients presenting with diabetic ketoacidosis (DKA), the plasma creatinine concentration can be elevated due to three causes. First, diabetic patients may have an elevated plasma creatinine due to the presence of diabetic nephropathy.
What are the 3 diagnostic criteria for DKA?
DIFFERENTIAL DIAGNOSIS
Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap.
What is DKA in pediatrics?
Diabetic ketoacidosis (DKA) in children is defined as a blood glucose level over 11 mmol/L, venous pH below 7.3 or serum bicarbonate level below 15 mmol/L, and either the presence of ketonemia (blood β-hydroxybutyrate level ≥ 3 mmol/L) or moderate to high ketonuria.
What is the anion gap for DKA?
In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L.
When should insulin be administered in DKA?
When the patient is able to tolerate oral intake and DKA is resolved, transition to subcutaneous insulin must be initiated. It is common to see transition from intravenous to subcutaneous insulin using sliding scale insulin only.
Why do we give potassium in DKA?
After insulin treatment is initiated, potassium shifts intracellularly and serum levels decline. Replacement of potassium in intravenous fluids is the standard of care in treatment of DKA to prevent the potential consequences of hypokalemia including cardiac arrhythmias and respiratory failure.
Why is BUN and creatinine high in DKA?
Excerpt. Diabetic ketoacidosis is usually accompanied by dehydration resulting in prerenal azotemia, in which the levels of blood urea nitrogen are elevated out of proportion to those of the serum creatinine (1).
Why is there no insulin bolus in pediatric DKA?
While bolus insulin is common in the treatment of DKA in adults, it is relatively contraindicated in the pediatric patient. Dehydration and secondary sympathetic activation can interfere with local tissue perfusion and may cause irregular and unpredictable absorption.