Anak dan remaja dengan DKA harus diberi penatalaksanaan yang dapat mengontrol tanda-tanda vital, neurologis, dan laboratorium.1. Penilaian Kegawatdaruratan- Melakukan evaluasi klinis dan mencari bukti adanya infeksi.- Timbang berat badan pasien dan gunakan hasilnya untuk kalkulasi.- Nilai keparahan klinis dari dehidrasi- Nilai kesadaran (Glasgow Coma Scale). - Gunakan sampel darah untuk tes laboratorium terhadap plasma glukosa, elektrolit (termasuk bikarbonat atau karbondioksida total [TCO2], BUN, Kreatinin, osmolaritas, pH Vena, pCO2, Hemoglobin, dan hematokrit atau darah rutin, kalsium, fosfor, dan konsentrasi magnesium1. Emergency assessment Perform a clinical evaluation to confirm the diagnosis and determine its cause. Look for evidence of infection. Weigh the patient and use this weight for calculations. Assess clinical severity of dehydration. Assess level of consciousness (Glasgow coma scale). Obtain a blood sample for laboratory measurement of serum or plasma glucose, electrolytes (including bicarbonate or total carbon dioxide [TCO2]), blood urea nitrogen, creatinine, osmolality, venous (or arterial in critically ill patient) pH, pCO2, haemoglobin and haematocrit or blood count, calcium, phosphorus, and magnesium concentrations. The cause of a high white blood cell count is more often stress than infection. Perform a urinalysis or blood test for ketones (or point-of-care measurement on a fingerprick blood sample using a bedside meter if available). Obtain appropriate specimens for culture (blood, urine, throat), if there is clinical evidence of infection. If laboratory measurement of serum potassium is delayed, perform an electrocardiogram for baseline assessment of potassium status (see details of EKG features below under section 5: Potassium replacement). 2. Supportive measures Secure the airway and empty the stomach by continuous nasogastric suction to prevent pulmonary aspiration in the unconscious or severely obtunded patient. A peripheral intravenous catheter should be placed for convenient and painless repetitive blood sampling. A cardiac monitor should be used for continuous electrocardiographic monitoring to assess T-waves for evidence of hyperkalemia or hypokalemia. Give oxygen to patients with severe circulatory impairment or shock. Give antibiotics to febrile patients after obtaining appropriate cultures of body fluids. Catheterize the bladder if the child is unconscious or unable to void on demand (e.g. infants and very ill young children). 3. Fluids and salt replacement For patients who are severely volume depleted but not in shock, volume expansion (resuscitation) should begin immediately with 0.9% saline to restore the peripheral circulation. The volume and rate of administration depends on circulatory status and, where it is clinically indicated, the volume administered typically is 10 ml/kg/h over 1-2 hours, and may be repeated if necessary, to assure a stable circulatory status. In the rare patient with DKA who presents in shock or severe circulatory collapse, rapidly restore circulatory volume with isotonic saline in 20 ml/kg bolus infused as quickly as possible through a large bore cannula. Repeat if necessary, with careful reassessment after each bolus. Intraosseous access should be considered after multiple attempts to gain IV access have failed. Fluid management (deficit replacement) should be with 0.9% saline for at least 4-6 hours.