Initial bolus 20ml/kg NS x 1 (repeat boluses only for shock or poor perfusion)
If K+<5.5
0.45% NS (or NS) + 20 KPhosat 1.5 x maintenance rate
When BS <300, change to D5/0.45%NS (or NS) +20 KPhos at 1.5 x maintenance rate (maintain BS 150-250)
In a retrospective study, lactated ringers when compared with normal saline was associated with lower total cost and rate of development of cerebral edema. 
0.45% NS (or NS) + 20 KPhosat 1.5 x maintenance rate
When BS <300, change to D5/0.45%NS (or NS) +20 KPhos at 1.5 x maintenance rate (maintain BS 150-250)
When BS <300, change to D5/0.45%NS (or NS) +20 KPhos at 1.5 x maintenance rate (maintain BS 150-250)
Insulin drip 0.1 units/kg/hr
Do not start if K+ <4.0 (replete K+ first)
Continue until HCO3 >15 and pH >7.3, then transition to SC insulin
Decrease infusion to 0.05 units/kg/hr until 1hr after SC insulin initiated
Do not start if K+ <4.0 (replete K+ first)
Continue until HCO3 >15 and pH >7.3, then transition to SC insulin
Decrease infusion to 0.05 units/kg/hr until 1hr after SC insulin initiated
Decrease infusion to 0.05 units/kg/hr until 1hr after SC insulin initiated
if < 2.5, hold insulin and give 1 meq/kg [[potassium KCL in IV over 1hr
No insulin until K > 2.5
if > 2.5 but < 3.5 give 40-60 meq/L in IV until K > 3.5
if > 3.5 but < 5.5 give 30-40 meq/L in IV for K=3.5 - 5
if >  5.5, then check K q1hr
No insulin until K > 2.5
No evidence supports the use of sodium bicarb in DKA, with a pH >6.9
However, no studies have been performed for patients with pH <6.9 and the most recent ADA guidelines recommend it for patients with pH <7.1
Only consider for:
Critically ill (hemodynamic compromise from decreased contractility) AND
pH <7.0
0.5-2 mEq/kg over 1-2hr
Correction should never exceed pH > 7.1 or bicarb >10
Critically ill (hemodynamic compromise from decreased contractility) AND
pH <7.0
Correction should never exceed pH > 7.1 or bicarb >10
Cerebral edema (1% of DKA)
Acute change in mental status
Signs of herniation
If present, see Cerebral Edema in DKA
Acute change in mental status
Signs of herniation
Diabetic ketoacidosis 
Physiologic stress response 
Alcoholic ketoacidosis
Diabetes mellitus 
Starvation ketoacidosis
Nonketotic hyperglycemia
Cerebral edema in DKA
Hyperosmolar hyperglycemic state 