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DKA in children

Start this sheet when: Child or teenager with glucose 200 mg/dL (11 mmol/L) or more, or known diabetes, with ketones 3 mmol/L or more and pH below 7.3 or bicarbonate below 18. Think of it in any child with vomiting, deep fast breathing, belly pain or drowsiness plus thirst or weight loss.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Time since door

Targets met --Breaches 0

1.Triage, capillary glucose and ketones checked
≤ 15 min from door · Local target: bedside meter at triage
Enter door time
2.Weighed; blood gas with K+ and sodium back
≤ 30 min from door · Local target: weight drives every dose
Enter door time
3.IV fluid started (0.9% saline)
≤ 30 min from door · BSPED 2021: 10 mL/kg over 1 h; 20 mL/kg only if shocked
Enter door time
4.Potassium added to the fluid(Passing urine, K+ not high)
≤ 1 h from IV fluid start · BSPED 2021: KCl 40 mmol/L after the bolus
N/AEnter door time
5.Insulin 0.05-0.1 unit/kg/h started (no bolus)
1 h to 2 h from IV fluid start · BSPED 2021: 1-2 h after fluids; earlier adds cerebral oedema risk
Enter door time
6.Hourly neuro obs, glucose and fluid chart running
≤ 1 h from door · BSPED 2021: hourly, to catch cerebral oedema
Enter door time
7.Repeat blood gas with K+ and sodium
≤ 2 h from insulin start · BSPED 2021: 2 h after insulin starts, then 4-hourly
Enter door time
8.Senior paediatrician / PICU informed(pH below 7.1, under 2 years, or drowsy)
≤ 1 h from door · Local target: severe or high-risk child
N/AEnter door time
9.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
10.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Never an insulin bolus; start the drip 1-2 h after the fluid
☐Shock only: 20 mL/kg 0.9% saline; otherwise 10 mL/kg over 1 h
☐Deficit plus maintenance over 48 h, evenly; KCl 40 mmol/L in every bag
☐Glucose below 250 mg/dL: add 5-10% dextrose, keep insulin running
☐Headache, falling GCS, slow pulse: mannitol 0.5-1 g/kg or 3% saline 2.5-5 mL/kg
☐No bicarbonate: it adds to cerebral oedema risk
☐Strict input-output chart; nothing by mouth until improving
☐New diabetes: insulin, glucometer and teaching sorted before discharge

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Bedside checklist

☐Never an insulin bolus; start the drip 1-2 h after the fluid

☐Shock only: 20 mL/kg 0.9% saline; otherwise 10 mL/kg over 1 h

☐Deficit plus maintenance over 48 h, evenly; KCl 40 mmol/L in every bag

☐Glucose below 250 mg/dL: add 5-10% dextrose, keep insulin running

☐Headache, falling GCS, slow pulse: mannitol 0.5-1 g/kg or 3% saline 2.5-5 mL/kg

☐No bicarbonate: it adds to cerebral oedema risk

☐Strict input-output chart; nothing by mouth until improving

☐New diabetes: insulin, glucometer and teaching sorted before discharge