Fluid Replacement in Diabetic Ketoacidosis
This must take account of:
- The likely fluid deficit (typically 100 mL/kg body weight)
- The blood pressure, central venous pressure and urine output
- Coexisting cardiac or renal disease
- Give normal saline 1L IV over 30–60 min (give the faster rate if systolic BP is <90 mmHg), followed by 1L over 1h, without added potassium. Consider placement of a central line to monitor central venous pressure (CVP) in patients with cardiac or renal failure.
- Give further normal saline (with potassium added according to the plasma level, see Table 83.4). As a general guideline, for an adult with DKA (average fluid deficit 6L) and systolic BP >90 mmHg, the following regimen can be used:
- 1L normal saline over 1h
- 1L normal saline (with added potassium) over the following 2h
- 1L normal saline (with added potassium) over the following 2h
- 1L normal saline (with added potassium) over the following 4h
- 1L normal saline (with added potassium) over the following 4h
- 1L normal saline (with added potassium) over the following 6h
- Once blood glucose level falls <14 mmol/L, glucose 10% should be given at a rate of 125 mL/h alongside the saline infusion, at the rate required to correct fully the fluid deficit.
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