Diabetic ketoacidosis protocol toolkit

The BCCH DKA protocol has now been revised to conform to the ISPAD's Clinical Practice Consensus Guidelines 2009 Compendium (see below). If you have any queries related to the management of DKA in children, please contact the Pediatric Endocrinologist on call.

The following documents are available in Adobe® PDF (portable document format). This requires the use of the Adobe® Acrobat® Reader plug-in , which can be downloaded free of charge.

The protocol and accompanying documents can be downloaded in a single document, the BCCH DKA Protocol Toolkit, or as individual documents:

Download the entire BCCH DKA Protocol Toolkit

(2010/01/08 version)

Download the BCCH DKA Protocol Toolkit Cover Page (2010/01/08)
Download the BCCH DKA Medical Protocol (2008/09/21) PLAIN PDF FORMAT
Download the BCCH DKA Nursing Protocol (2010/01/08)
Download the BCCH DKA Flowsheet (2009/11/20)
Download the BCCH DKA Sample Physician Order Sheet (2009/10/30)
Download the BCCH Pharmacy Recipes for Making DKA Solutions (2008/09/21)

NEW! The BCCH DKA Medical Protocol can also be downloaded in FILLABLE PDF FORMAT.

The major modifications from the previous version (dated 2006/11/03) of the protocol include:

increased caution in the use of hypotonic fluids in the first 12–24 hours of DKA management
reinforcement of the pre-treatment need to assess the level of dehydration and extracellular volume contraction using e.g. hematocrit
increased attention to serum sodium levels and the appreciation of the coexistence of hypernatremic dehydration and/or the hyperglycemic hyperosmolar state with DKA
delay in the introduction of insulin infusions for the first 1–2 hours of DKA management
formalization of the use of the “two-bag system" to facilitate physician and nursing management of IV fluids

The changes were introduced to reflect an increased understanding in the medical literature of factors leading to complications, particularly cerebral edema, which arise during the treatment of DKA in infants, children and adolescents.

NEW! There is also an accompanying article entitled Diabetic ketoacidosis in children and adolescents: an update and revised treatment protocol in the January/February 2010 issue of the British Columbia Medical Journal describing the protocol and the management of DKA in children in more detail.

We hope that you will find these materials to be helpful in managing pediatric cases of diabetic ketoacidosis. Please do not hesitate to contact the Endocrinology & Diabetes Unit at BCCH for any help in implementing this protocol at your health-care centre in British Columbia. We also welcome any suggestions to make this material more useful to your practice.

Other pediatric DKA protocols and consensus statements available on the Web:

Disclaimer: The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within British Columbia's Children's Hospital (BC Children’s). There are support systems at BC Children’s that may not exist in other clinical settings and therefore any adoption of these materials cannot be the responsibility of BC Children’s. Agencies other than BC Children’s should use this information as a guideline for reference purposes only. All materials are the property of BC Children’s and may only be reprinted in whole or in part with our expressed permission.

Page Last Updated: 2 February 2010

Links

Privacy

PHSA improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in collaboration with BC health authorities and other partners. For more information, visit http://www.phsa.ca

PHSA agencies include: BC Cancer Agency, BC Centre for Disease Control, BC Children’s Hospital and Sunny Hill Health Centre for Children, BC Mental Health & Addiction Services, BC Provincial Renal Agency, BC Transplant, BC Women’s Hospital & Health Centre, and Cardiac Services BC.