Table 4—

Replacement procedure for a child (weight 30 kg, surface area 1 m2) with DKA estimated to be 10% dehydrated

Approximate duration and rateFluid composition and volumeSodium (mEq)Potassium (mEq)Chloride (mEq)Phosphate (mmol)
Hour 1 (300 ml/h)300 ml 0.9% NaCl (normal saline)4646
Hours 2–4 (125 ml/h); start regular insulin at 0.1 unit · kg−1 · h−1375 ml (normal saline) + 20 mEq potassium acetate/l + 20 mEq potassium phosphate/l5815585.1
Hours 5–48 (125 ml/h); continue regular insulin (0.1 unit · kg−1 · h−1 until pH ≥7.3 or HCO3 ≥18 mEq/l)5,500 ml (one-half normal saline + dextrose) + 20 mEq potassium acetate/l + 20 mEq potassium phosphate/l42422042475
Total in 48 h6,175 ml fluid52823552880
  • Normal saline (10 ml/kg) is given over 1 h for initial volume expansion; thereafter, the child is rehydrated over 48 h at an even rate at two times the maintenance rate of fluid requirement. Potassium phosphate: 4.4 mEq potassium and 3 mmol phosphate (1 mEq potassium and 0.68 mmol phosphate).