- See:
- Stable HyperGly
- Sliding Scale
- Management of Stable DKA Patient
- Management:
- correct volume depletion;
- give 500 ml NS IV "wide open." then continue as needed;
- caution with CHF;
- begin insulin; - give 5-10 units of IV regular insulin as single dose by direct slow injection followed by an infusion rate based on chemstrip or glucometer readings, initially q1hr;
- don't use SC Insulin; may have poor circulation;
- d/c all SC insulin dosing and oral hypoglycemics;
- regular insulin can bind to plastic IV tubing;
- hence, 30-50 ml of infusion solution should be run thru IV tubing and discarded, before the IV tubing is attached to patient;
- ideal rate of blood glucose lowering is 75-100 mg/dL/hr;
- more rapid drop may lead to osmotically induced fluid shifts, manifested by confusion / CNS symptoms;
- start insulin infusion at 0.1 Units/kg/hr until plasma glucose reaches 250, then d/c insulin infusion and begin IV D5W;
- expect plasma glucose to fall about 10% over 2 hr;
- if glucose levels do not fall, then pt has insulin resistance and infusion rate must be increased to 0.15-0.2 Units/kg/hr;
- monitor Blood Glucose, Lites, ABGs for initial baseline & after 2hrs;
- watch for:
- hypophosphatemia:
- metabolic acidosis: bicarbonate if pH < 7.1; - hypolkalemia:
- after IV NS & insulin are given & acidosis corrected, potassium deficit may become esp severe;
- when hypokalemia is first noted, add KCl to infusion, provided that pt is passing urine & Urea & Cr are normal;
- w/ concomitant RF pt may suffer iatrogenic Hyper Cl;
- in pts w/ severe electrolyte and mineral derangements, such as DKA and ETOH, some authors recommend administration of phosphorus, magnesium, and potassium in the same intravenous solution;
- 20 millimoles K Phos, 20 millimoles K Cl, & 4 ml of 50% Mg SO4 in 0.45% saline given q 8 hrs;
- A clinical approach to common electrolyte problems: 3. Hypophosphatemia.
The metabolic derangements and treatment of diabetic ketoacidosis.