علاج داء السكري من النوع الأول في الحماض الكيتوني السكري مع جفاف >5%، دون صدمة

References

DOI: 10.1016/j.jcjd.2017.10.036

• Dehydration >5%
• Not in shock
• Acidotic (hyperventilation)
• Vomiting
• In children in DKA, rapid administration of hypotonic fluids should be avoided.
• Replacement of fluid deficit should be extended over a 48-hour period with regular reassessments of fluid status.
• Add 40 mmol/L KCl
• In children in DKA, an intravenous insulin bolus should not be given.
• The insulin infusion should not be started for at least 1 hour after starting fluid replacement therapy.
• An intravenous infusion of short-acting insulin should be used at an initial dose of 0.05 to 0.1 units/kg/h, depending on the clinical situation.
• In children in DKA, once blood glucose reaches ≤17.0 mmol/L, intravenous dextrose should be started to prevent hypoglycemia.
• The dextrose infusion should be increased, rather than reducing insulin, to prevent rapid decreases in glucose.
• The insulin infusion should be maintained until pH normalizes and ketones have mostly cleared.
• Start SC insulin then stop IV insulin after an appropriate interval