Clinical Tools

Paediatric DKA Fluids

Maintenance + deficit estimate only

🔴 Not a full DKA protocol This estimates maintenance + fluid deficit only. Full DKA management (fluid bolus, IV insulin infusion timing/rate, potassium/electrolyte monitoring, cerebral oedema precautions) must follow CHQ-GDL-60016 or your local protocol, with senior paediatric input. For a critically unwell or deteriorating child, contact Retrieval Services Queensland (RSQ) on 1300 799 127. See the full DKA & New-Onset T1DM reference for pathophysiology, insulin/potassium protocol, cerebral oedema management and more.

Weight (kg) Dehydration (clinically assessed — required) Fluid Bolus Already Given (mL)

⚠️ Dehydration is often overestimated in DKA Per CHQ-GDL-60016: volume deficit in DKA is frequently overestimated, which can lead to over-resuscitation with IV fluids. Base your selection on clinical assessment (mucous membranes, skin turgor, capillary refill, urea/anion gap), not a guess. Deficit is replaced over 48 hours; urinary losses are not added to this initial calculation. Maintenance uses the reduced-rate DKA formula (<10 kg: 2 mL/kg/hr · 10–40 kg: 1 mL/kg/hr · >40 kg: 40 mL/hr) — deliberately lower than standard Holliday-Segar/4-2-1 maintenance, to reduce cerebral oedema risk.

Reference: DKA severity & ketones

DKA diagnosis requires ALL of: BGL > 11 mmol/L, venous pH < 7.3 and/or HCO3 < 18 mmol/L, and moderate/large ketonaemia/ketonuria.

	Mild	Moderate	Severe
pH / HCO3	7.2–7.3 or HCO3 <18	7.1–7.2 or HCO3 <10	<7.1 or HCO3 <5
Dehydration estimate	~5%	~7%	~10%

Blood ketones (Abbott meter)	Low/Small	Moderate	High/Large
mmol/L	<0.6	0.6–<1.5	≥1.5

Source: Children's Health Queensland — "Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic State (HHS): Emergency management in children" (CHQ-GDL-60016, v6.0, effective 26/07/2024, review date 09/07/2028).