Diabetic Ketoacidosis (DKA) Clinical Pathway – Emergency Department, ICU and Inpatient – Goals and Metrics

Diabetic Ketoacidosis (DKA) Clinical Pathway – Emergency Department, ICU and Inpatient

Goals of Therapy

Correct Dehydration Conservative fluid resuscitation starting with 10 mL/kg bolus of normal saline
Careful reassessment to avoid contributing to risk of cerebral edema
Correct Ketoacidosis Start insulin after the initial hour of fluid resuscitation
Do not use insulin bolus, it increases the risk for cerebral edema
Normalize Blood Sugar Aim to drop glucose by 50-100 mg/dL per hr
Avoid Complications Anticipate and evaluate for cerebral edema
Assess mental status and neurologic exam frequently during treatment
Treat Precipitating Event Evaluate for underlying cause (infection, trauma, ingestion)

Metrics

Cohort: Child's with diagnosis of diabetes mellitus, types I, II and DKA