• Summary: “Karen Value An Omelet with Goat Cheese”

1. Stabilize ABCs (primary survey), initial resuscitation

2. IV Potassium → PREVENT Hypokalemia - ↓K (<3.5) (K+ < 5.5 ) when administrate insulin

   • Usually takes 1h

     K+ < 3.3 mmol/L	Give 40 mmol/L KCL → Give IV Insulin
     K = 3.3 - 5.5	Give 10-40 mmol/L
     K > 5.5	Give IV Insulin

   

3. IV Fluid Resuscitation → Treat !Hypovolemia ↓ (hypovolemia), also have Blood glucose lowering effect

   

4. IV Insulin → Treat Ketone (early stage) and ↑ Hyperglycemia (> 7) (later stage)

   • If K+ < 3.3 mmol/L, don’t give INSULIN
   • Monitor by Anion Gap (<12), continue until Anion Gap is normalized (not when blood glucose is normalized)
   • If blood glucose is corrected but Anion Gap is not:
     • Continue IV insulin, add IV hypotonic (Dextrose/D5W) to prevent Hypoglycemia ↓( ≤ 4) and Cerebral Edema

1. Slowly correct Serum Osmolality (275-295) (< 3 mmol/kg/h)

   <aside> 💡

   Fast correction (rapid drop in glucose) → risk of Cerebral Edema , first priority in children***

   </aside>

   • Normal Saline (higher osmolarity)
   • IV hypotonic (Dextrose/D5W)

2. ID precipitating cause

3. Slowly transition to SCSC Insulin

   • Must be after the resolution of acidosis
   • Time the transition (IV has short half life):
     • Stop IV 4h after injection of Basal SC
     • Stop IV 2h after injection of Rapid SC

Keep a flow sheet