In severe DKA, always start regular insulin infusion at the rate of 0.1 IU/kg/hour AFTER bolus fluid 20 ml/kg NS or RL over one hour . When child is improving ( signs of acidosis are decreased) usually after 6-12 hours, then taper regular insulin infusion from 0.1 to 0.05 IU/kg/hour. In less than 4 years age children with mild to moderate DKA, we can start regular insulin infusion 0.05 IU/kg/hour after bolus fluid. 🙏🙏
Very nice presentation mam! Mam how much keones in urine considered to b fullfilling the criteria if we dont have access to blood ketones level?. 2+ or 3+
Superb mam. Thanks teachers like you are there who wants to share the knowledge unlike shit professors sitting in medical Colleges who are good for nothing.
There is an unavoidable iatrogenically induced rise in serum chloride with the use of normal saline in the initial resuscitation of children presenting in DKA and shock. The incidence of hyperchloremia is significantly less with the use of half normal saline. Half normal saline is not associated with a decline in the corrected serum sodium concentration and does not affect the rate of correction of acidosis or rate of drop in blood glucose or duration of DKA resolution when compared to normal saline solution as post-bolus rehydration fluid therapy in pediatric patients with DKA. Read this article for details- www.researchgate.net/publication/350566485_Outcome_of_the_use_of_09_saline_versus_045_saline_for_fluid_rehydration_in_moderate_and_severe_diabetic_ketoacidosis_in_children
Very very thanks mam every teaching class of u helping very much mam pls make video on management of electrolyte imbalance and acid base disorders thanku mam
Maam, you explained so nicely...but in routine practice clculations make the procedure more scary to try.. i mean we have to practice lot in order to get used to the calculations
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Ma'am how have you calculated regular insulin infusion rate i.e. 2.08ml/hour? Plus do we always dilute the regular insulin in 50 ml NS? Please clear my queries ma'am, I'll be highly obliged :)
Hello Fatima, 50 ml ➗ 24 hours =2.08 ml/hour. No, it's not necessary to dilute in 50 ml fluid. But it's easy to use 50 ml syringe in syringe pump, so we generally do this.
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