DKA FLUID & INSULIN CALCULATOR*
*To be used in conjunction with PCH DKA guideline
  Name  
  DOB
Age: years Date Printed: 
 
 
  Enter Patient's Weight  kg
 
Estimate % dehydration
% (max 5)  
 
Total Fluid Bolus Given  ml - if requiring >20ml/kg, seek senior advice (ED consultant/ICU)
(Fluid boluses should only be given if patient is clinically shocked or under senior advice)
             
NOTE: It is the responsibility of the treating clinician to check patient's date of birth and weight are correct.
Calculations should be double checked before prescribing fluid and insulin.  
             
Fluid  
Initial fluid should be Sodium chloride 0.9% only
             
To calculate fluid rate:
A    
B  
     
This deficit is replaced over 48 hours      
Calculate daily maintenance fluid:          
Body Weight Fluid Requirement      
3-10kg 100mL/kg/day      
10-20kg 1000mL + (50mL/kg/day for each kg >10kg)      
>20kg 1500mL + (20mL/kg/day for each kg > 20Kg)      
             
     
             
Fluid rate equals (2 x daily maintenance + deficit) ÷ 48.       
           
             
Total fluid rate = ml/h        
 
Change to a potassium chloride containing solution once serum potassium <5mmol/L and patient has passed urine.
Initially use 40mmol Potassium chloride in 1000mL fluid.      
Once blood glucose is <15mmol/L, change fluid to glucose containing solution: Sodium chloride 0.9% + Glucose 5%  
Occasionally 7.5% to 10 % glucose may be required (falling or persistently low blood glucose when receiving glucose 5%).
Do not change insulin infusion rate unless discussed with endocrinology.
 
Insulin
 
Subcutaneous insulin (use insulin pens if available)
If pH is >7.2, subcutaneous insulin may be used.
 
Give an initial 0.1 units/kg subcutaneously  units of Actrapid
Then 0.1 units/kg every 2 hours units of Actrapid until acidosis is corrected.
Continue insulin according to Endocrinology advice.
 
Insulin Infusion
For pH <7.2 or if an insulin infusion is indicated:
 
Make up 50 units of Actrapid in 50ml of Sodium chloride 0.9% (1unit/ml)
Prime line with 20ml of solution before commencing infusion.
             
     
     
    ml/h (max 5 units/hr)      
 
DO NOT GIVE IV INSULIN BOLUSES  
 
Monitor blood glucose hourly when initially commenced on insulin infusion.
Electrolytes should be monitored 2-4 hourly as clinically indicated.
             
             
Caution: Rapid changes in fluid, electrolytes and serum osmolality can cause cerebral oedema.
Monitor changes in GCS or mental state. Fluid management may need to be altered accordingly.
If in doubt, discuss with senior clinician.  
 
Calculator updated April 2024