Veterinary DKA Calculator: Streamline Insulin Infusion & Electrolyte Management

Patients Parameters

Body weight (kg)

Bag #1 - Insulin bag

Bag/syringe/burette volume (ml)

Fluid type

Bag #2 - Electrolyte bag (+/- dextrose)

Bag/syringe/burette volume (ml)

Fluid type

Desired fluid rate via Bag 2 (ml/hr)

Phosphate supplementation rate (mmol/kg/hr)

Potassium chloride supplementation rate (mEq/kg/hr)

Desired final dextrose % in Bag 2 (%)

Dextrose % to be added to Bag 2 (%)

Bag #3 - Dextrose/Hydration bag (+/- KCL)

Bag/syringe/burette volume (ml)

Fluid type

Desired fluid rate via Bag 3 (ml/hr)

Potassium chloride supplementation rate (mEq/kg/hr)

Desired final dextrose % in Bag 3 (%)

Dextrose % to be added to Bag 3 (%)

Bag 1 (Insulin CRI)

Calculated based on 0.1U/ml of insulin added into bag, which will provide insulin rate of 0.1U/kg/hr @ 1ml/kg/hr

Step 1: Add Units of regular insulin to ml of

Step 2: Run 50 ml of insulin CRI solution through the administration set prior to use

Bag 2 (Electrolytes +/- dextrose)

Step 1: Remove ml of a crystalloid solution from bag 2

Step 2: Add ml of KPO4 which contains mmol of PO4 (3 mM/ml KPO4 solution) to bag 2

Step 3: Add ml of KCL which contains mEq of KCL (2 mEq/ml) to bag 2

Step 4: Add ml of % dextrose solution to make ml of % dextrose containing solution

Bag 3a (With dextrose/hydration +/- KCL)

Step 1: Remove ml of a crystalloid solution from bag 3a

Step 2: Add ml of KCL which contains mEq of KCL (2 mEq/ml) to bag 3a

Step 3: Add ml of % dextrose solution to make ml of % dextrose containing solution

Bag 3b (No dextrose/hydration +/- KCL)

Step 1: Remove ml of a crystalloid solution from bag 3b

Step 2: Add ml of KCL which contains mEq of KCL (2 mEq/ml) to bag 3b

Fixed-rate insulin infusion order (sliding scale)

Blood glucose concentration		BAG #1 (Insulin bag)	BAG #2 (Electrolytes +/- dextrose)	BAG #3a (with dextrose)	BAG #3b (without dextrose)	Total rate (bag 1+2+3)
mg/dl	mmol/L	ml/hr	ml/hr	ml/hr	ml/hr	ml/hr
>270	>15			0
126-269	7-14.9				0
<126	<7	0			0
Phosphate supplementation, mmol/kg/hr				0
KCL supplementation, mEq/kg/hr
Total potassium supplementation (KCL + KPO4) in all bags combined, mEq/kg/hr
			Osmolarity in Bag 2	Osmolarity in Bag 3
KPO4 , mOsm				0
KCL, mOsm
Dextrose, mOsm
Fluid, mOsm
Final osmolarity, mOsm/L

Note: The osmolarity in bag #2 and 3 must not exceed 650 mOsm/L if this solution is given via a peripheral catheter or 1250 mOsm/L if it is given via a central line. If osmolarity exceeds 650 mOsm/L and the solution has to run via a peripheral catheter, increase the fluid rate in the bag #2 and/or #3 until osmolarity drops below 650.

Table 1 - Recommended rate of K+ supplementation (mEq/kg/hr)

K+ Plasma Concentration (mmol/L or mEq/L)	Rate of K+ Supplementation (mEq/kg/hr)	K+ Recheck Frequency
2-2.4	0.4-0.5	Q2-4h
2.5-2.9	0.3-0.4	Q6-8h
3-3.4	0.1-0.2	Q12-24h
3.5-4.5	0.05	Q24h
>4.5-5	Do not supplement

Table 2. Recommended rate of PO4 supplementation (mmol/kg/hr)

Degree of derangement	Patient's serum phosphate (mg/dl) or [mmol/L]	Rate of PO4 Supplementation (mmol/kg/hour)	PO4 Recheck Frequency
Mild hypophosphatemia	2-2.7 or [0.65-0.9 mmol/L]	0.01-0.02*	Q24H
Moderate hypophosphatemia	1-2 or [0.33-0.65 mmol/L]	0.03-0.06	Q12-24H
Severe hypophosphatemia	<1 or [<0.33 mmol/L]	0.06-0.12	Q8-12H

Note: * mild hypophosphatemia does not always require correction and can be monitored over time without treatment

About this calculator

This calculator is designed to help veterinarians calculate insulin infusion rate as well as potassium and phosphate supplementation rate in small animal patients with Diabetic Ketoacidosis (DKA) and/or Hyperosmolar Hyperglycemic State (HHS).

Insulin Infusion

This calculator is programmed to use the fixed-rate insulin infusion protocol (a 3-bag technique) with the maximum rate of insulin supplementation of 0.1 Unit/kg/hour when it is run at 1 ml/kg/hr (via Bag 1). The calculator will generate an insulin infusion sliding scale that will guide veterinarians and veterinary technicians on the rate of intravenous insulin and/or dextrose administration based on the current blood glucose levels that are monitored every 1-2 hours. When treating small animals with HHS, it may be recommended to decrease the insulin amount in the bag by half to provide insulin supplementation rate of 0.05 U/kg/hr at 1 ml/kg/hr (Bag 1). Ideally, the fluid rate via Bag 3 should be running at least 2 ml/kg/hr to provide sufficient dextrose supplementation during insulin therapy, however there may be some exceptions.

Ideally, the fluid rate via Bag 3 should be running at least 2 ml/kg/hr to provide sufficient dextrose supplementation during insulin therapy, however there may be some exceptions.

Osmolarity

The osmolarity in Bag 2 and 3 must not exceed 650 mOsm/L if this solution is given via a peripheral catheter. If osmolarity exceeds 650 mOsm/L and the solution has to run via a peripheral catheter, increase the fluid rate in Bag 2 and/or 3 until osmolarity drops below 650.

Phosphate Supplementation

This calculator is programmed to use the potassium phosphate (K-Phos) solution with concentration of potassium 4.4 mEq/ml and phosphate 3 mmol/ml (available in the USA and some other countries). Do not use the phosphate supplementation feature if this specific phosphate-containing product is not available in your country.

It is important to remember that phosphate-containing solutions are INCOMPATIBLE with solutions that contain any calcium salts such as LRS, calcium gluconate, etc. Potassium phosphate injection is reportedly physically compatible with the following IV solutions: dextrose (any concentration), 0.45% to 0.9% sodium chloride, and sterile water.

Read more about phosphate supplementation and calculation here –Intravenous phosphate supplementation in dogs and cats.

Potassium Supplementation

This calculator is programmed to use the potassium chloride solution with concentration of 2 mEq/ml (available in the USA and some other countries). Do not use the potassium supplementation feature if this potassium product is not available in your country.

It is not recommended to exceed 0.5 mEq/kg/hr (K max) of potassium supplementation, however there are some exceptions. Careful mixing of potassium chloride after addition to flexible bags of fluids is extremely important; the rates above >0.5 mEq/kg/hr can be used ONLY in situations of life-threatening symptomatic hypokalemia when you don’t have time to supplement potassium slower or during CPR. Patients receiving >0.4 mEq/kg/hr of K+ should receive constant ECG monitoring and serum K+ monitoring every 2-4 hours.

Read more about potassium supplementation and calculation here – Approach to Hypokalemia: Diagnosis and Treatment.

Small Animal Electrolyte and Acid-Base Mastery Certification Course (RACE-Approved for 12.5 CE hours)

If you are interested in receiving personal mentorship and want to truly master the management of electrolyte and acid-base disorders in dogs and cats, go to the VETEMCRIT ACADEMY!

Disclaimer

This veterinary DKA calculator is intended for informational and educational purposes only.

The creator of this tool is not responsible for clinical decisions or medical errors resulting from its use.

Users are encouraged to consult with a licensed veterinarian or medical professional to make informed decisions

DKA Calculator: Fixed-Rate Insulin Infusion and Electrolyte Supplementation

About this calculator

Insulin Infusion

Osmolarity

Phosphate Supplementation

Potassium Supplementation

Small Animal Electrolyte and Acid-Base Mastery Certification Course (RACE-Approved for 12.5 CE hours)

Disclaimer

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About this calculator

Insulin Infusion

Osmolarity

Phosphate Supplementation

Potassium Supplementation

Small Animal Electrolyte and Acid-Base Mastery Certification Course (RACE-Approved for 12.5 CE hours)

Disclaimer

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