Hyperkalemia: Calcium Gluconate 10%: 0.5-1.0 cc/kg IV over 5-10 min with monitor; Dextrose (50%): 0.5-1.0 g/kg IV over 15-30 min with 0.3 U Regular Insulin/g of Dextrose. Sodium Polystvrene Sulfonate (Kayexalate): 25% in Sorbitol Soln; 1 g/kg/dose q 6 hrs PO or q 2-6 hrs PR; NaHCO3 1-2 mEq/kg over 5-10min.

Hypokalemia: Maintenance 1-2 mEq/kg/day. Replacement 3-4 mEq/kg/day (if symptomatic [arrhythmias, K < 2.5 …] - replace at 0.3-0.5 mEq/kg/hr IV with cardiac monitor).

Hypoglycemia: Dextrose: Give 0.5-1.0 g/kg. Neonates - D-10, 1-2 ml/kg IV; Toddlers, Children - D-25 (0.25 g/cc), dose- 1-2 ml/kg; Older Children, Adolescents - D-50, dose- 1-2 ml/kg or adult dose; Work Up (before Dextrose given if able) - consider glucose, Insulin level, Glucagon, C-peptide, ketones, GH, Cortisol, Iytes (?AG), lactate, urine ketones

Diabetic Ketoacidosis (DKA): Etiology - lack of Insulin, infection, stress, dehydration…; Clinical - polyuria [DDx -DM, exogenous glucose-osmotic agent, Dl, excess fluid intake], polydypsia, weak, nausea, vomiting, abdominal pain, altered mental status, dehydration, acetone halitosis, Kussmaul resp; Labs - glucose > 250 mg/dl, acidosis (pH < 7.30), HCO3 < 15 mEq/I, hyponatremia (Na decreased 1.6 mEq/I per each 100 mg/dl glucose), total body K depletion, dehydration, ketonemia, ketonuria; Rx -ABCs; NS or RL 10-20 ml/kg IV bolus; Reg. Insulin 0.1 U/kg IVP x 1 then Insulin Drip: 0.1 U/kg/hr (50 U in 500 cc NS then run rate [cc/hr at wt in kg]); Fluids. - replace deficit (up to 10-15% and subtract initial bolus) with 0.45 NS over 48 hours steadily, and maintenance; Change IV to D5W or D5 1/4 NS with glucose at 250-300 mg/dl; Rx hypokalemia with KCI or KPhos; Beware cerebral edema (headaches, increaed risk < 5-6 years old, and first episode of DKA), and hypoglycemia (check glucose and urine ketones q 1 hour while on Insulin drip).

Adrenal Crisis: D5NS 20 ml/kg IV bolus; Hydrocortisone 1-2 mg/kg IVBP, then [1000 mls D5NS + 100 mg Hydrocortisone] IV at maintenance -or- Hydrocortisone 50 mg/m^2 IV q 6 hours. Clinical - shock, altered mental status, weak, nausea, vomit, abdominal pain, body aches, hyponatremia, hyperkalemia, metabolic acidosis, decreased serum cortisol.