Treatment involves administration of intravenous fluids and insulin. Children with diabetic ketoacidosis require serial laboratory studies for electrolyte derangements and close clinical monitoring for signs of cerebral edema, an uncommon but potentially fatal complication of pediatric diabetic ketoacidosis.
Herein, how do you calculate fluid deficit in pediatrics DKA?
For most children, use
| Weight | |
|---|---|
| >60kg | 35 ml/kg/24 hrs |
Thereof, how much fluid do you give DKA?
For adult patients with DKA, the American Diabetes Association recommends initial treatment with 1.0–1.5 L of 0.9% saline over 1 h, followed by continuous infusion with either 0.9% or 0.45% saline depending on serum sodium concentration [17].
What are the diagnostic criteria for DKA?
The diagnostic criteria for diabetic ketoacidosis are: ketonaemia 3 mmol /l and over or significant ketonuria (more than 2 + on standard urine sticks) blood glucose over 11 mmol /l or known diabetes mellitus. venous bicarbonate (HCO3 ) ) below 15 mmol /l and /or venous pH less than 7.3 (1)
What are the key nursing responsibilities when treating DKA?
Nursing Management
- Monitor vitals.
- Check blood sugars and treat with insulin as ordered.
- Start two large-bore IVs.
- Administer fluids as recommended.
- Check electrolytes as potassium levels will drop with insulin treatment.
- Check renal function.
- Assess mental status.
- Look for signs of infection (a common cause of DKA)
What are therapeutic procedures for DKA?
Treatment usually involves: Fluid replacement. You’ll receive fluids — either by mouth or through a vein — until you’re rehydrated. The fluids will replace those you’ve lost through excessive urination, as well as help dilute the excess sugar in your blood.
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 sliding scale for insulin?
The term “sliding scale” refers to the progressive increase in pre-meal or nighttime insulin doses. The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements.
What IV fluids are given for DKA?
Normal saline (0.9% sodium chloride) is the most commonly used intravenous fluid in treating DKA, but it has a very high concentration of chloride and can lead to additional acid production when given in large volumes.
What would be the appropriate therapy of a child with diabetic ketoacidosis *?
Insulin Replacement
Continuous, low-dose, intravenous (IV) insulin infusion is generally accepted as the safest and most effective method of insulin delivery for treating diabetic ketoacidosis.
When do you give sodium bicarbonate in DKA?
Consensus guidelines for the management of DKA recommended administering sodium bicarbonate to DKA patients who present with an initial blood gas pH of < 7.0. That recommendation was updated and changed in 2009 to limit sodium bicarbonate use to DKA patients with blood gas pH of < 6.9.
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 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.