Question: My question is regarding fluid bolus for DKA. Past practice has been to initiate a BHP patch for direction to administer a fluid bolus. The most recent Provincial Protocol states that a patch is only necessary for DKA in patients under 12. Are we still required to patch for a fluid bolus for adults in DKA?
A Mandatory Provincial Patch Point is only required to administer a fluid bolus to a patient greater or equal to 2yo and less than 12yo. The rationale here is that volume overload and a rapid decline in serum blood glucose levels can lead to cerebral edema in this paediatric patient population. This serious complication is much less likely to occur in adults who often are significantly more dehydrated and/or can tolerate greater volumes of IV fluid, certainly the amount that can most commonly be administered in the pre-hospital setting.