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Flashcards in DKA Management Deck (29)
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1

what are the diagnostic criteria for DKA?

- serum glucose > 250 mg/dL
- arterial pH < 7.3
- serum HCO3- < 18
- at least moderate ketonuria or ketonemia

2

first step in treating DKA, after:

- complete initial evaluation
- check capillary glucose
- check serum/urine ketones
- confirm hyperglycemia
- check for ketonuria/ketonemia

start IVF: 1 L of 0.9% NS/hr

3

first step when determining which IVF to give

hydration status:

- severe hypovolemia
- mild hypovolemia
- cardiogenic shock

4

IVF if DKA pt has severe hypovolemia

0.9% NS 1 L/hr

5

next step if DKA pt has mild hypovolemia

evaluate CORRECTED serum Na+

6

next step if DKA pt has cardiogenic shock

hemodynamic monitoring/pressors

7

IVF if DKA pt has mild hypovolemia and HIGH serum Na+

0.45% NS, 250-500 mL/hr, depending on volume state

8

IVF if DKA pt has mild hypovolemia and NORMAL serum Na+

0.45% NS, 250-500 mL/hr, depending on volume state

9

IVF if DKA pt has mild hypovolemia and LOW serum Na+

0.9% NS, 250-500 mL/hr, depending on volume state

10

when do you change IVF to D5W/0.45%, and at what rate?

- serum glucose reaches 200 mg/dL
- 150-200 mL/hr

11

what are the 2 different options for insulin administration?

IV, or SC (if uncomplicated)

12

what is the dose of the insulin bolus?

0.1 U/kg

13

at what dose and rate is regular insulin given?

0.1 U/kg/hr IV continuous infusion

14

at what rate should regular insulin be given in continuous infusion if an initial bolus is not given?

0.14 U/kg/hr

15

what is the goal rate that serum glucose should fall?

50-70 mg/dL

16

next step if serum glucose does not fall by 50-70 mg/dL w/i FIRST hour

double insulin bolus

17

next step when serum glucose reaches 200 mg/dL

reduce regular insulin infusion to 0.02-0.05 U/kg/hr

18

between what levels should serum glucose be maintained, and until when?

- 150-200 mg/dL
- until RESOLUTION OF DKA

19

when is DKA considered to be resolved?

- normalization of serum AG (< 12 mEq/L) and blood beta-hydroxybutyrate levels
- when pts w/ hyperosmolar hyperglycemic state (HHS) are mentally alert and plasma Osm < 315 mOsmol/kg
- pt is able to eat

20

how often should labs (electrolytes, BUN, venous pH, creatinine) be checked?

2-4 hrs, until STABLE

21

next step after resolution of DKA/pt able to eat

- initiate SC multidose insulin regimen
- CONTINUE IV insulin infusion for 1-2 HOURS after SC insulin is given

22

in insulin NAIVE pts, what is the starting dose for SC insulin?

0.5 U/kg to 0.8 U/kg body weight per day (adjust as needed)

23

first step in assessing potassium in DKA

establish adequate renal function (UO about 50 mL/hr)

24

if serum K+ < 3.3 meq/L

- HOLD INSULIN
- give K+ 20-40 meq/hr until > 3.3 meq

25

if serum K+ > 5.3 meq/L

- do NOT give K+
- check K+ every 2 hrs

26

if serum K+ is 3.3-5.3 meq/L

give K+ 20-30 meq/LITER of IVF

(keep K+ between 4-5 meq/L)

27

assessing need for HCO3-:

pH 6.9 or MORE

NO HCO3-

28

assessing need for HCO3-:

pH LESS THAN 6.9

dilute NaHCO3 (100 mmol) in 400 mL H2O w/ 20 meq KCl; infuse over 2 hrs

29

NaHCO3 administration should be given how often, and until when?

Q2H until pH > 7.0