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Publication Date



These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly, these guidelines should guide care with the understanding that departures from them may be required at times.

Objective of the Guideline

The objective of this guideline, besides standardizing care and the benefits associated with care standardization, is to correct dehydration and acidosis, reverse ketosis, restore blood glucose to near normal, avoid complications of therapy (including cerebral edema), and identify and treat any precipitating event(s) to prevent future DKA.

Target Users

Physicians, nurse practitioners and staff nurses caring for children, with DKA, in Emergency Departments, outpatient settings and inpatient settings.

Clinical Questions Answered by Guideline

1. In the pediatric patient presenting with DKA which route (intravenous or subcutaneous) of insulin therapy is most efficacious in resolving DKA?


Diabetic Ketoacidosis; Insulin; Hyperglycemic Hypersmolar Syndrome; DKA; HHS




NOTE: Initial Finalized: April 29, 2013; Revisions: 4/13; 1/14; 9/14; 12/14; 12/15, 12/16;11/19; 07/21

Initial Diabetic Ketoacidosis

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