Nurses Helping Nurses
allnurses Network: Central | Jobs | Books | Newsletter
allnurses: A Nursing Community for Nurses
Home General News Blogs Articles Students Region Specialty Degrees F.A.Q.
Diabetes / Endocrine Nursing /

DKA and fluid resuscitation



Did You Know?
allnurses is the largest community for nurses on the web. We now have over 388,725 members! Join today to network with other nurses, laugh, share, and much more.

Sep 02, 2007 05:34 PM

DKA and fluid resuscitation


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?


Share

Search Tags
None
Top

 
Advertisement
Sponsored Links
 
Reply
8 Comments
No. 1
from deeDawntee
Old Sep 02, 2007, 06:35 PM
Updated Sep 02, 2007 at 06:39 PM by deeDawntee

Default Re: DKA and fluid resuscitation
Hi!
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.
Top

1 Reader Gave Kudos
 
No. 2
from GingerSue
Old Sep 02, 2007, 08:30 PM

Default Re: DKA and fluid resuscitation
"...infusion of dextrose 3.3 percent and sodium chloride 0.3 percent (2/3 and 1/3) IV solution

but on the next page - about Emergency Mangement of DKA:
fluid resuscitation with 0.9 % NaCl solution


thanks,
but it's 3.3% not 33% (so this would be the usual 2/3 - 1/3)
Top
 
No. 3
Old Sep 02, 2007, 08:36 PM

Default Re: DKA and fluid resuscitation
We always seem to use LR for DKA resusciatation, and we never add the K until I know it's under control, since it's normally sky high!

We also watch as the BS returns to 250, and then begin to add the D5...
Top
 
No. 4
Old Sep 03, 2007, 08:38 AM

Default Re: DKA and fluid resuscitation
Remember, water follows sugar (and salt). If all the sugar is in the blood, not the cells, then the patient is dehydrated. This can lead to organ failure. So the first step is to correct dehydration. Later you add K or Dextrose, but NS comes first.
Top
 
No. 5
from talaxandra
Old Nov 11, 2007, 11:06 AM

Default Re: DKA and fluid resuscitation
We always start with N/saline, run K+ according to serum potassium (from 20mmol/hr if the K+ is less than 3.5mmol/L to 5 mmol/hr if it's over 5), and add 5% dextrose when the BSL hits 15mmol/L (270mg/dL).
The N/S is to counter dehydration, the K= replacement because IV insulin causes potassium to shift out of the blood stream, and the dextrose slows the drop in serum glucose because sudden shifts in serum glucose increase the risk of long-term diabetic complications.
Top
 
No. 6
from Nrs_angie
Old Nov 18, 2007, 07:56 PM

Default Re: DKA and fluid resuscitation
Originally Posted by deeDawntee View Post
Hi!
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.
Dawn hit the nail on the head....

couldn't have said better myself
Top
 
No. 7
Old Nov 21, 2007, 08:42 AM

Default Re: DKA and fluid resuscitation
Initial treatment will probably be NS. I know for sure that is the only IV fluid on the EMS ambulances in our county.

DKA causes dehydration. NS is generally used initially, then other fluids may be added depending on lab values. I think your textbook is confusing, but when tested I would go with NS.
Top
 
No. 8
from ckc6977
Old Nov 22, 2007, 03:18 AM

Default Re: DKA and fluid resuscitation
I concur with the other previous posts. At our facility we begin the pt on NS (usually c K+ supplements added also of course c the insulin gtt). Once the BG levels are </= 250, we'll switch the IVF to D5NS, D51/2NS.
Top
 
Reply




Thread Tools


Who's Online
200 members
1,768 guests
1,968

3

Four Lehigh Valley Health Network nurses accused of...

46

lawsuit - But don't most RN's work through breaks/lunch...

0

Patient Evaluation of Retail Clinic Care

7

The hard to reach on-call doctor, and its effects on...

10

Woman charged with passing off prescription drug as...

23

Man in "Vegetative State" was conscious for 23...

2

Interesting article on ThedaCare's Collaborative Care Model

14

Possible breakthrough regarding MS

63

16th Philly area hospital to stop delivering babies: Mercy...

14

Really interesting article on Indian open hearts



44

Dear preceptor

1

Society Needs Care Too

13

Why am I doing this, anyway?

2

Nurse Heal Thyself

10

My Papa, why I am the nurse I am today.

17

I made it through

11

An angel's gaze

16

A Sister Never Forgets

16

Ruby's Marbles

42

What Do Operating Room Nurses Do?

14

My Little Old Jedi

21

I love this job......

23

"I hear voices"

20

Preventing FRUTI (Foley Related Urinary Tract Infection) in...

24

Error and Attitude





Sponsored Links

Currently Reading This Page: 1 (0 members & 1 guests)

Interested in the hottest topics of the week? Subscribe to the Nurse-zine Newsletter.
Enter email address: