Table 1 (abstract A62). Key points of Italian DKA management

Begin with an isotonic solution (0.9 % saline) at 5–10 ml/kg/h over 90–120 min (not exceeding 300 ml/h); do not use colloids

At the beginning of hydration if hypokalemic, but at the latest from the start of insulin therapy, add potassium (20 mmol/L before or 40 mmol/L from the start of insulin infusion) as 50 % potassium chloride and 50 % potassium phosphate

Start IV insulin infusion as human regular insulin not before 90–120 min and never give an insulin bolus. It is recommended to utilize an automated syringe for insulin delivery

The recommended insulin dosage is 0.05–0.1 U/kg/h according to patient’s age, but less insulin (0.025–0.05/kg/h) is better and safer

Continue from the third hour with 0.9 % saline

The rate of IV fluid should be calculated to rehydrate evenly over at least 48 h; be careful not to exceed 1.5 times the daily maintenance

When the blood glucose level drops to 250–300 mg/dl (14–17 mmol/l), or decreases faster than 100 mg/dl (6 mmol/l))/h, add glucose 5–10 %, but the fluid replacement should continue to have a tonicity equal to or greater than 0.45 % saline

The use of bicarbonate is not recommended