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
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
Yes. Why? Rate? Why?
OK, IVF's high to dilute and flush, then to hydrate and replace electrolytes prn?
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?
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
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
Specializes in Education, FP, LNC, Forensics, ED, OB.
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........
Specializes in Education, FP, LNC, Forensics, ED, OB.
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?
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UM Review RN, ASN, RN
1 Article; 5,163 Posts
Ummmm.... still guessing, but ......
Fluid replacement?
This article mentions isotonic fluids.
http://en.wikipedia.org/wiki/Diabetic_ketoacidosis