DKA protocol?

NtannRN · Jan 15, 2010

We don't have anything specific, Blood sugar over 300, elevated gap, + urine ketones. They're put on an isulin gtt with usually a 3 unit regular insulin bolus then started at 3 or 5 units/hr. D5 us usually hung in conjunction with the insulin gtt. pt is kept npo. and blood glucose us checked every hour and the insulin gtt is titrated according to a sliding scale protocol. Oh, IVF are usually run at a pretty good clip, 200 or so/hr. I can't really think of anything else off the top of my head. Hope this helps.

detroitdano · Jan 15, 2010

We have an excellent DKA protocol. Last DKA admit I had came in at 2300 and by 0600 I had him off insulin, IV fluids, his gap was closed, potassium was perfect and he was getting orders to head to a GPU.

We start with bolus' and then depending on if they have CHF or other comorbidities, they get 0.9% at a certain rate for 4 hours, 0.9% decreased to another rate for 12, then 0.45% as a maintenance.

For insulin/D5.45, we give them a bolus of insulin if need be, then we titrate the insulin and D5.45 every 2 hours according to a chart.

For potassium, we have a chart that determines what they get. IIRC if they are equal to or less than 4.0 we give them some, more than our usual ICU potassium replacement protocol usually calls for as well (3.9 with K protocol would merit 20 mEq, 3.9 with DKA protocol gets you 40, for example).

Blood sugars Q2H, lytes and VBG's are done Q4H.

NtannRN · Jan 16, 2010

I wish we had a more definate protocols instead of badgering the resident every 1hr. We do have lyt protocols but if there's any renal imparement they're not on lyt sliding scales. Working nights we really only have the icu resident to work with so they usually go by whatever they're doing in the Boston Hosp. they're from.

Iseeyou_RN, RN · Jan 17, 2010

The main points of our protocol (off the top of my head) are start an insulin gtt with 10 unit bolus, normal saline bolus of two liters, then .45 NS at prescribed rate, chem7 ketones and venous pH checked every 4 hours,if K+ drops below 5 add potassium to iv fluids and when blood sugar is

That's about what I can remember hope it helps :)