DKA Fluids Calculator

Row	Glucose : Insulin Ratio (g : unit)	Insulin* Rate (mL/hr)	Rate WITHOUT Dextrose (mL/hr)	Rate WITH D10% (mL/hr)	Total Fluid Rate (mL/hr)	Effective Dextrose Conc. (%)

Row	Glucose : Insulin Ratio (g : unit)	Insulin* Rate (mL/hr)	Rate WITHOUT Dextrose (mL/hr)	Rate WITH D12.5% (mL/hr)	Total Fluid Rate (mL/hr)	Effective Dextrose Conc. (%)

* Insulin infusion is a 1 unit/mL solution. Green row = starting row when blood glucose < 300 mg/dL.

Using the Calculator

1. Enter Patient Name as a label for the printout — not transmitted or saved.
2. Enter Patient Weight in kg or lb.
3. Enter Insulin Dose (default 0.1 unit/kg/hr). Insulin infusion is a 1 unit/mL solution.
4. Enter Rehydration Rate either as mL/hr or as a multiple of maintenance fluids (× maintenance). Leaving the field blank sets it to maintenance × 2. Consider using the Dehydration Correction Calculator to calculate the rehydration rate based on the patient's weight and degree of dehydration.

A. Objectives

1. Correct dehydration by administering a fluid bolus followed by a rehydration regimen. Use the fluids available in the DKA Order Set; refrain from building custom fluids. All fluids should be based on normal saline or Lactated Ringer's.
2. Correct ketoacidosis by administering insulin.
3. Reduce blood glucose while keeping the Rate of Fall at 50–100 mg/dL per hour. Add glucose at a low rate if needed to slow the descent.
4. Once blood glucose reaches the Target Range (200–300 mg/dL), add glucose at a rate that prevents further fall — approximately 3 g glucose per unit of insulin. Adjust as needed.
5. Continue until ketones have cleared.
6. At the next meal, convert to subcutaneous insulin per the Endocrinology conversion plan.

B. Using the Output

1. After the initial fluid bolus, recheck blood glucose and start with Row 0.
2. If the Rate of Fall is > 100 mg/dL/hr, go to the next row (below).
   If the Rate of Fall is < 50 mg/dL/hr, go to the previous row (above).
3. When blood glucose falls below 300 mg/dL, go to Row 3 (highlighted green).
   If blood glucose falls below 200 mg/dL, go to the next row.
   If blood glucose rises back above 300 mg/dL, go to the previous row.
   If blood glucose continues to fall at the highest glucose:insulin ratio (Row 6), change to D12.5% (WITH ELECTROLYTES) and use Table 2.

• Target Range: 200–300 mg/dL
• Target Rate of Fall: 50–100 mg/dL per hour
• If the maximum glucose:insulin ratio is insufficient, increase the total fluid rate before decreasing the insulin rate.

Frequently Asked Questions

1. What do I do if blood glucose keeps falling at the maximum dextrose rate?
   Increase the Rehydration Rate to 2.5× maintenance or higher. If all else fails, reduce the insulin rate, accepting slower ketone clearance.
2. How do I pick which fluids to order?
   Use the DKA Order Set fluids. Never order fluids without sodium. D10NS is made by adding hypertonic saline to D10W. D10LR is not available (adding dextrose to D5LR dilutes electrolytes unacceptably). Phosphate cannot be added to LR (contains calcium).
3. What is the rationale for the three-bag system?
   See the DKA Presentation and DKA Algorithm for the evidence base, including data on rehydration rates and cerebral oedema, and the relationship between patient weight, insulin rate, and glucose infusion rate.