≈ 154.3 lb
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1 · Patient labs
Corrected Na = Na + (glu − 100) × 0.016 = 141.6 mEq/L (≥ 140 — gold/blue branch) · K⁺ bucket 4.0–5.1
2 · Recommendation
Initial recommendation
Start insulin drip at 7 u/hr (0.1 u/kg/hr)
NS bolus 15–20 mL/kg (1050–1400 mL over 1 hr) then maintenance at 250–500 mL/hr
BLUE column · fluid: ½ NS + 20 mEq KCl/L
Phase: Phase 1 · titration step ±3.5 u/hr · Recheck BG q1h, BMP q2–4h.
3 · Recheck & re-evaluate
Recheck labs & current drip rate
Comparing against previous BG 450 · K 4.1 · Na 136(from initial labs)
Reference — protocol details
Reference — protocol details
Insulin drip — weight-based step sizes
Initial
7 u/hr
0.1 u/kg/hr
Phase 1 step
3.5 u/hr
0.05 u/kg/hr
Phase 2 step
1.8 u/hr
0.025 u/kg/hr
Max start 15 u/hr · Phase 1 step max 5 u/hr · Phase 2 step max 2.5 u/hr.
Protocol fluid columns
Each column is defined by two thresholds — corrected Na and BG — and points to a specific fluid based on potassium.
RED
Corrected Na
< 140 mEq/L
Blood glucose
> 250 mg/dL
Recommended fluid
K⁺ > 5.1NS (no KCl)
K⁺ 4.0–5.1NS + 20 mEq KCl/L
K⁺ < 4.0NS + 20 mEq KCl/L + K replacement order-set
When BG drops ≤ 250 → switch to GREEN
GREEN
Corrected Na
< 140 mEq/L
Blood glucose
≤ 250 mg/dL
Recommended fluid
K⁺ > 5.1D5NS (no KCl)
K⁺ 4.0–5.1D5NS + 20 mEq KCl/L
K⁺ < 4.0D5NS + 20 mEq KCl/L + K replacement order-set
When BG drops ≤ 250 → switch to — do not return to RED
BLUEActive now
Corrected Na
≥ 140 mEq/L
Blood glucose
> 250 mg/dL
Recommended fluid
K⁺ > 5.1½ NS (no KCl)
K⁺ 4.0–5.1½ NS + 20 mEq KCl/L
K⁺ < 4.0½ NS + 20 mEq KCl/L + K replacement order-set
When BG drops ≤ 250 → switch to GOLD
GOLD
Corrected Na
≥ 140 mEq/L
Blood glucose
≤ 250 mg/dL
Recommended fluid
K⁺ > 5.1D5 ½ NS (no KCl)
K⁺ 4.0–5.1D5 ½ NS + 20 mEq KCl/L
K⁺ < 4.0D5 ½ NS + 20 mEq KCl/L + K replacement order-set
When BG drops ≤ 250 → switch to — do not return to BLUE
Phase 1 — initiation (goal BG ↓ 50–100 mg/dL/hr until BG < 250)
Hourly BG change
Action
BG drops 50–100 mg/dL/hr
Continue rate
BG drops < 50 mg/dL/hr (or rises)
↑ Increase by 3.5 u/hr
BG drops > 100 mg/dL/hr
↓ Decrease by 3.5 u/hr
BG < 250 mg/dL
Halve rate → Phase 2
Phase 2 — maintenance (goal BG 160–200 mg/dL until DKA resolves)
Hourly BG
Action
BG 160–200 mg/dL
Continue rate
BG > 200 mg/dL
↑ Increase by 1.8 u/hr
BG < 160 mg/dL
↓ Decrease by 1.8 u/hr
BG < 100 mg/dL
HOLD · recheck 1 hr
BG < 60 mg/dL
HOLD · hypoglycemia protocol
After hold, BG > 100
Resume at lower rate
Transition / disposition
- DKA resolution: AG closed (≤ 12), HCO₃ ≥ 18, pH ≥ 7.30, patient tolerating PO.
- Overlap SC long-acting insulin 1–2 hours before stopping drip.
- Monitor BG q1h on drip · BMP q2–4h · Mg / Phos q6h.
Educational aid only — verify against local DKA protocol & ADA guideline.