Can someone explain this please?

Specialties Endocrine

Published

What is the rationale of giving a bolus of 1L NS for hyperglycemia?

On the floor, we usually give insulin injections or insulin drips. In the ER, the nurse told me when I asked her last night why I was getting the bolus, she could only say, "that's what we give all diabetics with high blood sugar".

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....any blood sugar of more than 400 has a factor of dehydration......

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Specializes in Emergency room, Flight, Pre-hospital.

morte is right the hyperglycemic patients are usually dehydrated, also alot of times these patients can become acidodic and the fluids help to reverse and/ or combat the acidosis.:idea:

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Specializes in ER, NICU, NSY and some other stuff.

Also depends on how high the sugar is. Are we talking >400? Such as a ketoacidosis? N/V/D are a good precipitator. Along with the NS bolus it is typical to give reg insulin, sodium bicarb to correct the acidosis along with the elevated sugar.

Please bear with me if I am rambling, I am running on hour 29 right now and am getting a little fuzzy around the edges.

Normally NS would NOT be your ONLY intervention, you would also be giving insulin,(or should).

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Also depends on how high the sugar is. Are we talking >400? Such as a ketoacidosis? N/V/D are a good precipitator. Along with the NS bolus it is typical to give reg insulin, sodium bicarb to correct the acidosis along with the elevated sugar.

Please bear with me if I am rambling, I am running on hour 29 right now and am getting a little fuzzy around the edges.

Normally NS would NOT be your ONLY intervention, you would also be giving insulin,(or should).

I was a bit disappointed in the doctor I saw. I don't think he was very thorough and the ER wasn't even busy. My BG was 497 when I checked it (4 hrs postprandial) and then I drank two glasses of water and took my meds (it was time for them). By the time I it was checked in the ER, it had come down to 431. The only labs they did was a BMP and that was when the IV was started. Then they did another fingerstick about 3 1/2 hrs later & it was 301. They didn't do a U/A either. I've had moderate to heavy ketones in my urine since finding out I'm diabetic a month ago, but I was so foggy headed and feeling so horrible, I didn't even think to tell them about the ketones. I would think that the doctor would've thought to check it anyway since someone with diabetes who isn't feeling well when their blood sugar is elevated may not think too clearly.

Another thing...I became awfully swollen while receiving the bolus. I've never noticed any patients I've given a bolus to doing that. Is this normal after only one liter? My head was elevated, but my eyes were very puffy and my fingers were too. After I left the ER, the supervisor told me to go up to the floor to tell them I was leaving because they'd been very worried about me. As soon as I got there, they noticed first thing how swollen I was and told me I looked horrible. If they noticed it that quickly, don't you think the doctor should have too?

However, like I said, no other labs were drawn. So, they have no idea what it did to my K+ level. I guess since it was normal at first, one liter wouldn't make that much difference? All the doc said was to follow up with my MD this week.

The only abnormal labs pre-bolus were:

Sodium 134

Carbon Dioxide 19

Anion Gap 21

Glucose 431

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