DKA · HHS — Adult

≈ 154.3 lb
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Labs
Anion gap
25
Corrected Na
140.6
Eff. osm
295
DKA: AG > 12, HCO3 < 18, glu > 250, ketones+. HHS: glu > 600, eff osm > 320, minimal ketosis, AG < 12.
Fluids — first hour
NS bolus 15–20 mL/kg
1,050–1,400 mL
After bolus:
  • Corrected Na normal/high → ½NS at 250–500 mL/h
  • Corrected Na low → NS at 250–500 mL/h
  • Switch to D5-containing IVF when glucose ≤ 200 (DKA) or ≤ 300 (HHS)
Insulin
Gtt 0.1 u/kg/h
7 u/h
Bolus (optional)
7 u IV
ADA: bolus not required if gtt ≥ 0.14 u/kg/h
Goal glucose ↓ 50–75 mg/dL/hr. Halve gtt rate when adding D5.
BG titration → inpatient phase

Hourly recheck and rate stepping are handled in one place on the inpatient page so each recheck is logged in a single trend.

Open DKA Evaluator →
Potassium plan
Add 20–30 mEq KCl per L of IVF
  • K < 3.3: hold , KCl 20–40 mEq/h
  • K 3.3–5.3: 20–30 mEq KCl per L IVF
  • K > 5.3: no replacement, recheck q2h
48-hour fluid + insulin plan
Assumed deficit (% body weight)

Typical: DKA 5–7% (~5–7 L for 70 kg); HHS 8–12% (~8–12 L). Avoid overestimating.

Initial bolus (15 mL/kg 0.9% NaCl)
Each bolus / total (1×)
1,050 mL · total 1,050 mL
Maintenance / 24 h2,500 mL
Deficit (6% × 70 kg)4,200 mL
Bolus already given− 1,050 mL
Total over 48 h8,150 mL
Infusion rate
170 mL/hr

Use 0.9% NaCl initially; switch to ½NS once corrected Na normal/high. Cap rate at 250–500 mL/hr typical adult range.

Insulin infusion
Regular insulin gtt @ 0.1 U/kg/hr
7 U/hr

Hold insulin if K⁺ < 3.3 until replaced. Goal glucose ↓ 50–75 mg/dL/hr.

Current glucose → IVF mix
0.9% NaCl (or ½NS if corrected Na high) + K. Continue insulin gtt at 0.1 U/kg/h.
Insulin stop criterion
AG currently 25 (need ≤ 12). Continue gtt until AG closed — NOT just glucose normalized.
Glucose plan
Continue NS / ½NS at maintenance · insulin gtt running
Closure tracker
ABG / VBG · Bicarb decision

Per ADA: bicarb only for pH < 6.9. Otherwise risks outweigh benefit.

Note: decision logic is driven by pH and K⁺ (with hemodynamic status as a modifier) and applies to both DKA and HHS. HHS is typically non-acidotic, so bicarb is rarely indicated — but the same pH/K⁺ thresholds apply if acidosis coexists.

Summary · DKA & HHS
Awaiting inputpH — · K⁺ — mEq/L
Recommendation
Awaiting input
Enter pH to evaluate.
Cautions
  • Always co-administer K⁺; bicarb drives K⁺ intracellularly.
  • Avoid in pediatrics (cerebral edema risk) unless pH < 6.9 with arrest/peri-arrest.
  • Recheck pH, HCO₃, K⁺ every 1–2 h while infusing.
  • Stop once pH ≥ 7.0 — do not normalize with bicarb.
Look for trigger
Infection · MI · pancreatitis · non-compliance · pregnancy · steroids · SGLT2 (euglycemic DKA).
Hand off to inpatient phase →

Educational aid only — verify against local DKA/HHS protocol & ADA guideline.