Diabetic ketoacidosis

Paediatric emergency management · Endocrine · Metabolic

Hyperglycaemia + ketonaemia/ketonuria + acidosis (pH <7.3 or HCO₃ <15). Assess dehydration and conscious level; weigh cerebral-oedema risk.

Fluids

• If shocked, 10 mL/kg isotonic bolus (cautious) and reassess.
• Then replace deficit evenly over 48 h plus maintenance; avoid rapid osmolar shifts.

Insulin & potassium

• Start insulin infusion 0.05–0.1 U/kg/hr about 1–2 h after fluids begin – not as a bolus.
• Add potassium once K⁺ known and urine passed; monitor hourly glucose, add glucose to fluids when glucose falls.