03-04-2010, 09:46 PM
at what level of serum glucose do they start again d5 1/2ns or any other combination. is it 240 ?
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dka - lsdjlkj
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03-05-2010, 04:36 AM
MRI -- to see central pontine myelinosis like picture. Too rapid lowering of sugar can affect serum osmolality rapidly ---> can cause Central pontine mylinosis like changes.
03-05-2010, 05:19 AM
CT b/c we're looking for the signs of cerebral edema (hyponatremia due to aggressive fluids management)
03-05-2010, 05:49 AM
what will we look for on the CT scan if pt has cerebral edema?
03-05-2010, 08:04 AM
Good question. I think the answer here is CT scan, looking for cerebral edema, caused by a sudden, large shift in serum osmolality. Without the evidence to back this up....cerebral edema is usually well identified in other scenarios on Ct scanning (brain tumor, CVA, etc...) If the question had been regarding HONK, then the answer would be MRI as the pathophysiology is different. Rapid shifts in Na cause central pontine demyelinosos (imaging for this purpose would be MRI).
03-05-2010, 08:06 AM
PS. The question specifically refers to sudden drop in glucose (ie osmolality) rather than over-zealous infusion of IV fluids. Therefore cerebral edema and CT scan rather than MRI and CPD are the issues here.????
03-05-2010, 08:19 AM
CT signs of cerebral edema include effacement of sulci and basal cysterns... The most common cause of CE in DKA management is overzealous hydration
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