- 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,
ABG's 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; - Berkelhammer & Bear, 1984; ------------------------------------------------- The metabolic derangements and treatment of diabetic ketoacidosis. Foster DW. McGarry JD. New England Journal of Medicine. [JC:now 309(3):159-69, 1983 Jul 21.
