. Author manuscript; available in PMC: 2023 Apr 25.

Published in final edited form as: Pediatr Diabetes. 2020 Dec 3;22(2):148–160. doi: 10.1111/pedi.13152

TABLE 3.

Current treatment guidelines for management of diabetic ketoacidosis

	Treatment guidelines^a
Intravenous fluid therapy	• Initial volume resuscitation with 10–20 mL/kgof 0.9% saline over 30–60 min; additional boluses or faster infusion may be required to ensure adequate tissue perfusion • Subsequent fluid therapy with 0.45% to 0.9% saline (or balanced salt solution), incorporating maintenance requirements and deficit replacement over 24–48 h • Increase in sodium content of fluids is recommended if the measured serum sodium is low and does not rise appropriately as the blood glucose drops
Insulin therapy	• Initiation of insulin infusion at 0.05–0.1 units/kg/h at least 1 h after starting fluid replacement therapy • Avoidance of intravenous boluses of insulin
Bicarbonate therapy	• Reserved for life-threatening hyperkalemia and severe acidosis with concern for compromised cardiac contractility

Based on International Society for Pediatric and Adolescent Diabetes guidelines⁶ and a recent review on diabetic ketoacidosis.¹¹⁵