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Home | Articles | Diabetes and Endocrinology | Paediatric Ketone Correction Guideline

Paediatric Ketone Correction Guideline

Last updated 23rd March 2023

Where indicated, Calculate dose for ketones and compare it with the correction dose. Give whichever dose is higher- Not Both 

Blood ketones (mmol/l)Blood glucose <4mmol/lBlood glucose 4.1 – 9.9mmol/lBlood glucose 10 – 14mmol/lBlood glucose >14mmol/l
<1mmol/l• Treat hypo
• Consider 20% reduction in insulin dose
• give extra carbohydrates food or drinks to replenish stores*		encourage oral fluids and recheck  in 2-4hoursGive correction with meals using usual correction factorGive correction with meals using usual correction factor
1.0 – 1.4mmol/l• Treat hypo
• no extra insulin
• give extra carbohydrate food or drinks to replenish stores*		• starvation ketones
• give extra carbohydrate containing food to replenish stores
• give ordinary bolus if eating		Add +5% TDD  ** or give correction dose whichever is higher
 
Oral Sugar free fluid		Add 10% TDD** or give correction dose whichever higher
 
Oral sugar free fluids
1.5 – 2.9mmol/l****-Recheck blood sugar and ketones.
• Treat hypo
• give extra carbohydrates food or drink to replenish stores*
• consider IV 5% glucose infusion		If eating give ordinary bolus or Give 5% of the total daily dose**
• Oral sugar fluids
• Extra CHO*		Add 10% TDD** or give correction dose whichever is higher
 
Oral sugar free fluids		Add 20% TDD** or give correction dose whichever is higher
 
Oral sugar free fluids
>3mmol/l****
There is a risk of DKA if ketones are >3mmol/l		Recheck blood sugar and ketones. • Treat hypo
• give extra carbohydrates food or drink to replenish stores*
• give IV 5%glucose infusion at normal maintenance rate		Give 5% of total daily dose**
Encourage oral fluids		Add 20% TDD ** or give correction dose whichever higher
• Oral sugar free fluids
• Ensure patient not in DKA***		Add 20% TDD ** or give correction dose whichever higher
• Oral sugar free fluids
• Ensure patient not in DKA***

Please use Novorapid or Humolog administered through an insulin pen. TDD= Total daily dose – see calculation

  • *Extra carbohydrates- extra carbohydrates are required to switch off the production of starvation ketones.
  • The following foods contain about 10g of carbohydrates:-  50-55ml of original lucozade, 90ml of original cocacola, 200ml of milk and 100ml of apple juice
  • **calculate dose for ketones and compare it with the correction dose. Give whichever dose is higher- Not Both
  • *** Consider checking  blood gas to ensure patient is not in DKA
  • ****If managing patients who are at home using this guideline consider admitting patients in this group
(TDD) Total daily dose calculation for a 10 year
Basal levemir- 6 units morning, 8 units in the evening
Novorapid:-
              4 units on average with breakfast
3 units on average with lunch
  5 units on average with evening meal
Total daily dose= 6+8+4+3+5= 26units
5% TDD= 1.3 units
10% TDD= 2.6 units
20%%TDD=5.2 units
Correction factor = 100/26= 4		Deciding whether to use Correction dose or ketone dose
 
Example – 10 year old admitted to ward unwell, still drinking, miserable and febrile- wants to take 30g of carbohydrates with lunch. Pre lunch blood sugar- 22mmol/l,  ketones 2.9mmo/l. Usual lunch ratio = 1:10g
Total daily dose= 26 units
• Correction dose using correction chart= 3 units
• Ketone dose =20%TDD= 5.2 units- so use ketone dose as higher
• Insulin for food = 3units
Novorapid dose= 3units +5.2 units =8.2 units= 8 units- to be given before the meal.