USMLE forum
Step 1
Step 2 CK
Step 2 CS
Matching & Residency
Step 3
  <<   < *  Step 3   *  >   >>  

* CCS -case DKA
  future2017 - 07/04/18 08:21
  Please clarify the sequence of the order, if there is a missing order ,add or modify the sequence

1- VS, pulse oximetry
2- PE
3-order:finger stick Gl, ABG,UA,BMP/CMP ,CBC , Osmolality serum ,ketone bodies serum ,phosphorous, Magnesium, ,Beta hydroxybutyrate? ,serum Amylase ,Lipase
UA/Urine culture, blood culture ,ECG


5-NL S bolus , regular insulin IV, Phenergan IV one time( if vomiting) ,KCL IV(if KABx(Genta+Cefotaxime)

6- clock...

7- change location ->ICU
8-Order : NPO, VS, pulse oximetry ,finger stick , ABG,BMP every 1 hour ,urine output,


10-if improvement-> BSstart half saline +5-10% Dextrose +insulin infusion +K replacement( if K level is < 5.3,no ECG changes ,normal renal function ) , if pulse oximetry is normal(D/C oxygen)

11-monitor-> if no vomiting ,D/C IV fluid, Insulin--> oral , transfer to ward

12-Discharge with SC NPH insulin, SC regular insulin , Diabetes education

Report Abuse


* Re:CCS -case DKA
  usmlestudycase - 07/04/18 23:45
  @future2017: Everything is perfect. The only thing to add is continue with NS until the fingerstick is 200 and above. Once FS is comes to 200 or less then switch to D5w with half NS.
Than until Anion gap closes continue with IV insulin.
After that let IV insulin and subQ insulin overlap for at least overlap for 2 hours then DC IV insulin.
Your sequence is perfect.
Report Abuse

* Re:CCS -case DKA
  usmlestudycase - 07/04/18 23:49
  Sorry for the typos. :D
Report Abuse

* Re:CCS -case DKA
  mrsr5 - 07/07/18 20:59
  The Sequence matters, right? Silly qs, sorry, ofc, it would matter, b/c in a way, the sequence reflects your approach to the case, right? (which is what you are scored on)  
Report Abuse

          Page 1 of 1          

[<<First]   [<Prev]  ... Message ...  [Next >]   [Last >>]

Logon to post a new Message/Reply




Step 1 Step 2 CK Step 2 CS Matching & Residency Step 3 Classifieds
LoginUSMLE LinksHome