Diabetes mellitus type 1
ICD-10 E10 · ICD-11 5A10

Treatment of Type 1 Diabetes in Diabetic Ketoacidosis with Dehydration >5%, Not in Shock

Clinical Scenario

This protocol covers a patient with Type 1 diabetes who presents in diabetic ketoacidosis with dehydration exceeding 5%. The patient is not in shock but is acidotic — evidenced by hyperventilation — and is vomiting.

Key Presenting Features

The combination of diabetic ketoacidosis, significant dehydration (>5%), metabolic acidosis with hyperventilation, and vomiting defines this sub-population. The absence of haemodynamic shock distinguishes it from more severe DKA presentations requiring escalation.

Treatment Approach (Partial Overview)

Management involves intravenous fluid replacement to correct the fluid deficit, followed after an appropriate interval by a continuous intravenous insulin infusion, with careful electrolyte supplementation and structured monitoring of glucose and ketones throughout — the complete sequencing, parameters, and transition criteria are detailed in the full protocol.

Clinical Targets

Success is defined by improving acidosis with normalisation of pH and clearance of ketones, blood glucose decreasing to ≤17.0 mmol/L, and the patient being clinically well and tolerating oral fluids.

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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
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