Pediatrics
Pediatric DKA 48-Hour Fluid Deficit & Two-Bag Resuscitation Protocol (ISPAD / PECARN)
Calculates ISPAD 48-hour fluid replacement, maintenance rate, potassium repletion, and cerebral edema precautions.
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Parameters
Pediatric DKA 48-Hour Fluid Deficit & Two-Bag Resuscitation Protocol (ISPAD / PECARN) Result
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Formula
48-Hour Deficit Replacement = (Weight [kg] × Dehydration % × 1000 - Initial Bolus) ÷ 48 hours
Total Hourly Rate = Hourly Deficit Rate + Hourly Maintenance (Holliday-Segar)
Insulin Drip = 0.05–0.10 Units/kg/hour (started 1 hour after IV fluids)Clinical Pearls
The international gold standard protocol for pediatric DKA, proven in landmark PECARN trials to optimize recovery while minimizing cerebral edema.
Limitations
Calculations assume normal renal perfusion; once anuric renal failure is suspected, fluid replacement must be restricted.