🧒 Pediatric Diabetic Ketoacidosis Fluids (DKA)
This calculator structures pediatric diabetic ketoacidosis fluid and insulin therapy by the ISPAD framework: initial bolus, deficit-plus-maintenance replacement over 24–48 hours, insulin infusion and potassium.
Pediatric Diabetic Ketoacidosis Fluids (DKA)
Weight (> 75 kg, calculate as 75 kg) (kg)
Degree of dehydration
Shock / hypotension
When to use
Use in children with DKA to compute the initial bolus, the 48-hour fluid rate, the insulin infusion rate and potassium replacement.
How it works
Initial isotonic bolus 10–20 mL/kg (shock 10/dose, repeat up to 40); deficit = % dehydration × weight; total = deficit + 2× Holliday-Segar maintenance, given over 48 h; insulin 0.05–0.1 U/kg/h started 1 h after fluids, no bolus; KCl 40 mmol/L; weight capped at 75 kg.
Key points
- Insulin is started about one hour after fluids begin and is never given as an IV bolus, reducing the risk of rapid osmotic shifts.
- Resuscitation boluses are not subtracted from the calculated deficit, and dextrose is added once glucose falls to roughly 14–17 mmol/L.
- Deteriorating consciousness, headache, bradycardia or rising blood pressure signals possible cerebral edema, treated with mannitol or hypertonic saline and CT imaging.
References
- Glaser N, et al. ISPAD Clinical Practice Consensus Guidelines 2022: DKA and HHS. Pediatr Diabetes 2022.
- Kuppermann N, et al. PECARN DKA FLUID Trial. N Engl J Med 2018.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.