Management of Electrolyte and Glucose Imbalances

Hyperglycemia Management

• The American Diabetes Association recommends administering IV bolus of regular insulin at 0.15 units/kg body weight for adult patients with DKA, once hypokalemia is excluded 1
• The American Diabetes Association suggests following the insulin bolus with a continuous infusion of regular insulin at 0.1 unit/kg/hour (5-7 units/hour in adults) for DKA treatment 3
• Initial fluid therapy with isotonic saline (0.9% NaCl) at 10-20 ml/kg/hour is recommended for HHS treatment, according to the American Diabetes Association 1, 3
• The American Diabetes Association advises targeting a glucose decline rate of 50-75 mg/dl/hour for hyperglycemia treatment 1, 2
• For pediatric patients with DKA or HHS, the American Diabetes Association recommends fluid therapy at 1.5 times maintenance requirements (5 ml/kg/hour) and avoiding exceeding twice the maintenance requirement 1, 3

Special Considerations

• The American Diabetes Association recommends correcting serum sodium for hyperglycemia by adding 1.6 mEq to measured sodium for each 100 mg/dl glucose above 100 mg/dl 1, 2
• The American Diabetes Association suggests monitoring for hypokalemia during insulin therapy to prevent complications 1, 2