Pediatric patient with DKA - insulin bolus vs no bolus

[KimN]

Hey guys,

So I have been working on my case study for a pediatric patient that presents to the ED with DKA. As i'm doing my research I have been finding a lot of conflicting information about whether or not it is standard today to give an insulin bolus... a lot of resources are telling me that they are finding that the bolus is either not necessary or unsafe. Since I haven't been in a DKA situation myself I can't speak to what is currently practiced in my local hospital, although i'm assuming they do provide a bolus before starting a continuous drip. I will check their protocols in clinicals on Thursday though. Anyway, for the purpose of my assignment I am going to include the bolus as a treatment since that is what our current med/surg book says, but was just wondering... what do you guys think? Have you been in this situation and seen whether or not your facility gives an initial bolus?

Thanks :)

[nurseprnRN, BSN, RN]

insulin being a medication, you'll have a physician plan of care to tell you how to give it-- xyz units iv stat and then per sliding scale q xyz hours, maintenance gtt, or some other regimen. whether it's given iv bolus or by gtt is not your call.

[fromtheseaRN, BSN, RN]

every hospital will have a different protocol, so your goal here is to answer according to the book your class uses. if it says bolus, then by all means answer bolus!

[KimN]

Thanks for the responses! I don't think I did a very good job of wording my question. I was actually not intending it to sound like I was seeking advice about what I personally would do in that situation, but instead just trying to get some feedback on the research I was looking through. I definitely understand that a physician provides the orders ... I am a confused student, but I definitely know that ... PHEW! :)

It was really meant more out of interest because I had never heard this before and was wondering if it's something that was common. Also, I was wondering about the claim of it being unsafe for pediatric patients and wanted to see if anyone had any feedback. Although it is not my job to dictate the orders, it is mine to know when it is not safe to carry them out. And in the end i'm still a student which means I think too much about everything & am fascinated by new information. :)

[EricJRN, MSN, RN]

At some places it's a case-by-case decision, depending on the degree of acidosis (often looking at the bicarb level). When you check a facility's protocol, you might check into whether they have a target bicarb level and a target rate for the drop in glucose.

Some other things to think about: How fast would be too fast to drop the blood glucose? What are you worried about in that scenario? If the glucose starts to drop too quickly, what options are there?