Fluid prescribing is very important in DKA; giving too much fluid is potentially life-threatening.
Fluids should not be prescribed as per the usual paediatric regime but by DKA regime as set out in the guideline. Dehydration correction should be added on to this and given over 48 hours.
Assessment of dehydration is very subjective. The following may help:
- Mild (3%) dehydration is barely detectable
- Moderate (5%) dehydration leads to dry mucous membranes and reduced skin turgor
- Severe (>8%) dehydration leads to the above plus sunken eyes with poor capillary return. Child looks unwell.
Over-estimation of degree of dehydration is dangerous as over-zealous fluid administration may cause cerebral oedema.
Therefore do not use more than 8% dehydration in calculations.
To determine fluid correction to give:
Volume in ml = % dehydration x weight in kg x 10 [- any fluid boluses given]
(divide answer by 2 and add to maintenance volume to correct over 48 hours)