Monitoring of children during treatment for diabetic ketoacidosis

Parameter	Frequency	Comments
Vital signs	Hourly	Decrease in heart rate (not related to sleep or rehydration) or severe hypertension suggest possible cerebral injury.
Fluid intake and output	Hourly	Ensure ongoing positive fluid balance.
Neurologic status	At least hourly	Use GCS or similar assessment (refer to UpToDate content on cerebral injury in children with DKA).
Blood glucose	Hourly	Use a point-of-care meter, but cross-check with laboratory tests to ensure correlation.
Blood BOHB	Every 2 to 4 hours, if available	Perform if test is available. Resolution of DKA is indicated by BOHB ≤1 mmol/L (10.4 mg/dL).
Electrolytes, BUN, creatinine, venous blood gas	Every 2 to 4 hours	Timing of initiating potassium replacement depends on initial serum potassium level (refer to UpToDate topic text). Calculate the anion gap: Anion gap = sodium − (chloride + bicarbonate) Normal anion gap = 12±2 (in mEq/L or mmol/L); indicates resolution of DKA* Calculate the corrected sodium concentration: Corrected sodium = measured sodium + 1.6 (glucose − 100 mg/dL)/100 NOTE – For glucose measured in mmol, use: (glucose − 5.56)/5.56
Calcium, magnesium, phosphorus	Every 4 to 6 hours	More frequent measurements may be required for patients with significant derangements in these laboratory values.
ECG monitoring	Continuous, if available	Required for patients with severe DKA or significant electrolyte abnormalities (particularly potassium), but recommended for all patients.

GCS: Glasgow Coma Scale; DKA: diabetic ketoacidosis; BOHB: beta-hydroxybutyrate; BUN: blood urea nitrogen; ECG: electrocardiogram.

* Ketoacidosis can be considered resolved when the anion gap is normal (12±2 mEq/L or mmol/L), serum BOHB is ≤1 mmol/L (10.4 mg/dL), and venous pH is ≥7.3.

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Monitoring of children during treatment for diabetic ketoacidosis