dka - cricoid

[ArchivalUser]

1. decrease at 40-60mg/h
2. Change to D5/NS because you are at risk of dropping BG and inducing hypoglycemia. Also consider giving insulin SC and d/c pump in 1 hour as long as pt acidosis corrected. Consider also initiating PO and decresing rate of IV fluids to prevent overhydration
3. Cerebral edema/hyponatremia so confusion, changes in MS, up to seizures
4. intubate hyperventilate and use mannitol if needed since edema is osmotic...

[ArchivalUser]

All of you guys contributed well..........

1. decrease by 50-100mg/dl per hour
2. too rapid a drop in BS leads to cerebral edema...
3. change in iv fluids is partly to prevent cerebral edema as well.....besides other reason u all know...
4. cerebral edema treated with mannitol and dexamethasone....if does not work....intubate and hyperventilate...

great job guys...
thanks...
let me now if i am killing you guys........

[ArchivalUser]

ok, so, when do you stop giving insulin in DKA pt ?

[ArchivalUser]

you never stop giving insulin is type I diabetes! lol!!!!
You stop the pump but never stop giving insulin change from pump to sc

[ArchivalUser]

i meant to say that in terms of treating DKA

[ArchivalUser]

triple,

you stop the insulin drip once the BICARB n ANION GAP are normal........

[ArchivalUser]

when you have acidosis/ketosis controlled and pt is not vomiting and glucose <250mg/dl you start regular insulin sc and d/c pump in 1 hour...consider within that hour to begin PO also

IMPORTANT KEYS HERE:
pH is a good indicator of insulin deficiency so if low and not correcting pt needs more insulin!!!
hyperglycemia is a good indicator of HYDRATION not insulin needs....
make sure there is no ketosis or else pt will vomit and if you alreaady started PO this will bring pt back into DKA

[ArchivalUser]

also as yettobe said phosphate will drop as glucose and potassium are going back to normal, so you need to replenish phosphates or pt will not be able to produce enough ATP. To prevent that from happening potassium is added as KCL and K2PO4 (50/50)

[ArchivalUser]

bdj....great points....... thanks!
God i am happy for posting this set of qs.

[ArchivalUser]

ok cricoid, u got the "trophy" again for posting this Q !