🧒 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.
Insulin is started about one hour after fluids begin and is never given as an IV bolus, reducing the risk of rapid osmotic shifts.
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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.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Weight (> 75 kg, calculate as 75 kg) | 20 kg |
|---|---|
| Degree of dehydration | ~ 5% (mild) |
| Shock / hypotension | No |
→Fluid rate (48 h)83 mL/h
- Initial bolus：10–20 mL/kg = 200–400 mL isotonic fluid (over 20–30 min, max ~1000 mL). Resuscitation boluses are not subtracted from the deficit
- Fluid deficit：Estimated at 5% = 1000 mL; replaced together with maintenance over 24–48 h (here over 48 h)
- Maintenance：1500 mL/day (Holliday-Segar), 3000 mL over 48 h
| Weight (> 75 kg, calculate as 75 kg) | 20 kg |
|---|---|
| Degree of dehydration | ~ 10% (severe) |
| Shock / hypotension | Yes |
→Fluid rate (48 h)104 mL/h
- Initial bolus：Shock: 10 mL/kg = 200 mL isotonic fluid (0.9% NaCl or balanced crystalloid) given rapidly, may repeat 10 mL/kg up to 40 mL/kg as needed; if still unstable consider inotropes. Resuscitation boluses are not subtracted from the deficit
- Fluid deficit：Estimated at 10% = 2000 mL; replaced together with maintenance over 24–48 h (here over 48 h)
- Maintenance：1500 mL/day (Holliday-Segar), 3000 mL over 48 h
Frequently asked questions
- What is 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.
- How is Pediatric Diabetic Ketoacidosis Fluids (DKA) calculated? What is the core formula?
- 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.
- When is Pediatric Diabetic Ketoacidosis Fluids (DKA) used?
- Use in children with DKA to compute the initial bolus, the 48-hour fluid rate, the insulin infusion rate and potassium replacement.
- What are the key clinical points for Pediatric Diabetic Ketoacidosis Fluids (DKA)?
- 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.
- What are the limits and cautions when using Pediatric Diabetic Ketoacidosis Fluids (DKA)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Pediatric Diabetic Ketoacidosis Fluids (DKA) calculated in practice? Can you show a worked example?
- Inputs: Weight (> 75 kg, calculate as 75 kg) 20 kg, Degree of dehydration ~ 5% (mild), Shock / hypotension No → Result: Fluid rate (48 h) 83 mL/h（Initial bolus: 10–20 mL/kg = 200–400 mL isotonic fluid (over 20–30 min, max ~1000 mL). Resuscitation boluses are not subtracted from the deficit, Fluid deficit: Estimated at 5% = 1000 mL; replaced together with maintenance over 24–48 h (here over 48 h), Maintenance: 1500 mL/day (Holliday-Segar), 3000 mL over 48 h） Inputs: Weight (> 75 kg, calculate as 75 kg) 20 kg, Degree of dehydration ~ 10% (severe), Shock / hypotension Yes → Result: Fluid rate (48 h) 104 mL/h（Initial bolus: Shock: 10 mL/kg = 200 mL isotonic fluid (0.9% NaCl or balanced crystalloid) given rapidly, may repeat 10 mL/kg up to 40 mL/kg as needed; if still unstable consider inotropes. Resuscitation boluses are not subtracted from the deficit, Fluid deficit: Estimated at 10% = 2000 mL; replaced together with maintenance over 24–48 h (here over 48 h), Maintenance: 1500 mL/day (Holliday-Segar), 3000 mL over 48 h）