C'Mere & Play a New Game: "GIVE OR HOLD"? - page 2

Do you give these meds or hold them and why? Yes, you may call the doc, but at least take a guess as to what the doc will order. Tell us what you decide--give or hold--and say why. Then add... Read More

  1. by   Tweety
    Quote from siri
    40 y/o Type I DM with 24 hr hx n/v/low grade elevation

    what do you mean by "low grade elevation". I'm presuming a low grade temp?
  2. by   sirI
    Quote from Angie O'Plasty, RN
    Ummmm.... still guessing, but ......

    Fluid replacement?

    This article mentions isotonic fluids.

    http://en.wikipedia.org/wiki/Diabetic_ketoacidosis
    Yes. Why? Rate? Why?
  3. by   sirI
    Quote from Tweety
    what do you mean by "low grade elevation". I'm presuming a low grade temp?
    Yes. Low grade elevation is low grade temp. Pt. came from home.
  4. by   NP2BE
    need to start an insullin infusion and switch ivf to d51/2ns with 20of kcl (from NS after glucose gets under250), also ad bicarb, check calcium and mag levels too, may need to ad that.
    fluids should run at at least 150 but maybe higher
    Last edit by NP2BE on Dec 6, '05
  5. by   UM Review RN
    Quote from NP2BE
    need to start an insullin infusion and switch ivf to d51/2ns with 20of kcl (from NS after glucose gets under250), also ad bicarb, check calcium and mag levels too, may need to ad that.
    fluids should run at at least 150 but maybe higher

    Quote from Siri
    Yes. Why? Rate? Why?
    OK, IVF's high to dilute and flush, then to hydrate and replace electrolytes prn?
  6. by   UM Review RN
    Quote from siri
    Yes. Low grade elevation is low grade temp. Pt. came from home.
    Which leads me to ask more questions:

    If the temp would be from the trigger--an infection--UTI? So you'd also give ATB's, but which ones and how soon? Would the patient be given something like Rocephin in the ER right away or would that be dealt with after the DKA had stabilized somewhat?

    What would be considered "stablized"?

    A second set of ABG's and labs?
  7. by   NP2BE
    ivf high to hydrate, remeber dka will be spilling lots of urine. they will be losing electrolytes, especially potassium, two ways, one through spilling urine, the other when you start the insulin infusion, it will drive the potassium into the cells. mag and calcium frequently have to be replaced. bicarb to correct the acidosis, maybe push an amp or two then ad a few amps to the ivf.

    low grade temp is not significant at this point, but you can always to a cbc with diff and urine c&s if concerned
  8. by   NP2BE
    i would run a complete metabolic panel, or a basic metabolic panel and repeat every 4 hours unless signs and symptoms indicate need for immediate abg like kussmaul breathing and other signs of decline. but the patient will likely get better with ivf, lytes, insulin infusion
  9. by   NP2BE
    ready for another?
  10. by   sirI
    Quote from NP2BE
    need to start an insullin infusion and switch ivf to d51/2ns with 20of kcl (from NS after glucose gets under250), also ad bicarb, check calcium and mag levels too, may need to ad that.
    fluids should run at at least 150 but maybe higher
    Just checking, why add potassium to fluids? How did you arrive at that dose? When do you give the bicarb? If you do........
  11. by   sirI
    Quote from NP2BE
    i would run a complete metabolic panel, or a basic metabolic panel and repeat every 4 hours unless signs and symptoms indicate need for immediate abg like kussmaul breathing and other signs of decline. but the patient will likely get better with ivf, lytes, insulin infusion
    Exactly. You would most definitely perform full chemistry panel before any intervention with drugs. Why? Especially in this case?
  12. by   sirI
    Quote from NP2BE
    ivf high to hydrate, remeber dka will be spilling lots of urine. they will be losing electrolytes, especially potassium, two ways, one through spilling urine, the other when you start the insulin infusion, it will drive the potassium into the cells. mag and calcium frequently have to be replaced. bicarb to correct the acidosis, maybe push an amp or two then ad a few amps to the ivf.

    low grade temp is not significant at this point, but you can always to a cbc with diff and urine c&s if concerned
    What important piece of information do you need before you give bicarb in a pt. like this?
  13. by   sirI
    Quote from Angie O'Plasty, RN
    Which leads me to ask more questions:

    If the temp would be from the trigger--an infection--UTI? So you'd also give ATB's, but which ones and how soon? Would the patient be given something like Rocephin in the ER right away or would that be dealt with after the DKA had stabilized somewhat?

    What would be considered "stablized"?

    A second set of ABG's and labs?
    You can always start the abx in ER when the indication is there. No need to wait for DKA to resolve/stablize. Part of the "resuscitation" efforts.

    What labs????

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