DKA and HHS: insulin infusion, potassium, and fluids
Insulin drip rate, potassium rules, dextrose timing, and titration for hyperglycemic crises in adults.
Inputs
1 of 4Actual (total) body weight
Crisis
mEq/L
Optional, for titration.
Optional, for titration.
units/h
Patient values are shared with every calculator.
When to use
- Adults with DKA or HHS after initial fluid resuscitation.
Pearls and pitfalls
- Give 1 to 1.5 L isotonic fluid in the first hour unless contraindicated.
- Never start insulin with potassium below 3.5 mEq/L.
- Continue the infusion until the anion gap closes; overlap basal insulin 1 to 2 hours before stopping.
- Mild DKA can often be treated with subcutaneous rapid-acting insulin.
Why use
Puts the infusion, the potassium rule, and the dextrose switch in one place.
Insulin 0.1 units/kg/h (optional 0.1 units/kg bolus) or 0.14 units/kg/h without bolus; hold insulin if K < 3.5; add dextrose at glucose < 250 (DKA) or < 300 (HHS)