In my textbook, about DKA and its treatment:
"because fluid imbalance is potentially life threatening, the initial goal of therapy is to establish intravenous access and begin fluid and electrolyte replacement. Typically the initial fluid therapy regimen comprises an infusion of dextrose 3.3 percent and sodium chloride 0.3 percent (2/3 and 1/3)
IV solution premixed with a specified amount of potassium (KCL) at a rate to restore urine output to 30 to 60 mL/hr and to raise blood pressure. When blood glucose levels approach 14 mmol/L, 5 percent dextrose is added to the fluid regiment or prevent hypoglycemia"
but on the next page - about Emergency Mangement of DKA:
"begin fluid resuscitation with 0.9 % NaCl
solution until BP stabilized and urine output 30 to 60 mL/hr"
Is NaCl or 2/3 and 1/3 used to start fluid resuscitation?
Boy confusing, huh?
I just took and passed the CCRN exam and for their purposes the fluid of choice is NS (along with insulin gtt) until BG reaches about 250 and then to start fluids with dextrose. I imagine different institutions have different protocols though and of course would recommend following your institutions protocol. One does not want to drop these pt's glucose levels too low or too fast, and perhaps that is why the first fluid is recommended. Either way, what is important is to not let the pt's blood glucose get too low, because a paradoxical cerebral edema can result.
Another issue may be that I don't know of anywhere I have worked who stocks that Dextrose 33% and 0.3% saline. That sounds like something that pharmacy would have to mix up specially and there isn't always the time or a pharmacist available in all institutions.
Last edit by deeDawntee on Sep 2, '07