Diabetic ketoacidosis

Resuscitation

In shock with poor peripheral pulses, or coma

Oxygen 100% by face mask
Normal saline 0.9% 10 ml/kg over 10–30 min (should be repeated if peripheral pulses remain poor)
[Albumin 4–5% solution 10 ml/kg or other volume expanders may be used but there is no evidence that they are preferable]
Nasogastric tube to drain stomach if there is vomiting ± impaired consciousness

In most DKA protocols the fluid for resuscitation is not included in the calculations for later deficit dehydration.

If the child is in a location 1 h or more from a specialist center, Normal saline 0.9% should continue at 10 ml/kg per h for 1–2 h (thereafter 5 ml/kg per h)

Clinical observations and monitoring