06-03-2009, 12:38 PM
glucose 250?
regular or NPH?
regular or NPH?
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which insulin should be started s/c in DKA when - northeast
which insulin should be started s/c in DKA when - northeast
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which insulin should be started s/c in DKA when - northeast
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06-03-2009, 02:27 PM
dont start sc insulin immediately when sugar less than 250 ... sc insulin started only after the anion gap andacidosis are corrected ... till that time only insulin infusion.
06-03-2009, 02:28 PM
at glucose 250 start DNS with continuing insulin infusion and titrate insulin so that glucose is between 150 to 250
06-03-2009, 02:33 PM
Agree with harish...use SC regular insulin and NPH when ABG normalizes and glucose is in the 160 range. Do not discontinue the insulin drip immediately but wait for 30-60 minutes to avoid the re-development of DKA
As for the fluid change, when the glucose is 250, switch from normal saline to 5% dextrose in 1/2 normal saline. If you do not add dextrose, you risk inducing hypoglycemia. KCL infusion is started after 1 hour of the initial normal saline/IV regular insulin infusion. Do not administer KCL unless the initial K was less than 6. I struggled a lot with that topic and this is how I simplified it to myself. Hope it helps |
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