What should be administered to pediatric patients with blood glucose levels greater than 300 mg/dL and showing signs of DKA?

When managing pediatric patients exhibiting signs of diabetic ketoacidosis (DKA) and having blood glucose levels greater than 300 mg/dL, fluid resuscitation is a critical first step in treatment. The recommended practice involves administering an initial bolus of normal saline to address dehydration and electrolyte imbalances typically associated with DKA.

The choice of 20 mL/kg of normal saline IV/IO is established based on clinical guidelines aimed at effectively replenishing intravascular volume without overwhelming the child. Pediatric patients are particularly vulnerable to fluid overload, and thus a moderate bolus is advisable. This amount helps ensure adequate perfusion while reducing the risk of complications related to excessive fluid administration.

In contrast, selecting a higher volume, such as 30 mL/kg, 40 mL/kg, or 50 mL/kg, could pose risks, including fluid overload and potential cardiac complications. Therefore, the use of 20 mL/kg reflects a balanced approach to rehydrate these patients while adhering to recommended protocols for managing DKA in the pediatric population.