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23 Cards in this Set

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Deficient PMNs (polymorphonuclear leukocytes) become evident at what glucose level?
130-175 mg/dL
Diabetics with impaired PMNs render patients susceptible to what organisms?
Staph. aureus and E. coli.
Uncontrolled hyperglycemia can impair protein synthesis which can lead to what?
delay in tissue repair and regeneration
Why are oral hyperglycemics ineffective for hospitalized diabetic patients?
Because of increased secretion of catecholamines, cortisol, growth hormone and glucogon, which lead to an inhibition of insulin secretion and increases insulin resistance.
For a hospitalized diabetic, what is the general guideline for the total daily dose of insulin?
total daily dose of 0.50U/kg with about 75% of the dose used to control meal-mediated glycemia and 25% to control the overnight plasma glucose.
True or False:
Effective hospital management of the diabetic patient cannot be achieved with "sliding scale" coverage.
True.
What three things characterize Diabetic Ketoacidosis?
hyperglycemia, ketosis, and acidosis
What characterizes hyperosmolar hyperglycemia nonketotic syndrome?
plasma glucose about 600 mg/dL, plasma osmolality above 320, little or no ketonemia, and arterial pH above 7.30.
Is hyperosmolar hyperglycemia nonketotic syndrome more often present in type I or type II DM?
Type II diabetic over age 50
What type of DM is DKA more common in?
Type I DM
With a patient in DKA, how do you replace their fluids?
Replace fluid immediately with:
0.9% saline solution 1L/hr for the first two hours followed by 500mL/h for the next 4 hours, then 250 mL/hr thereafter.
In HHNS, how do you replace the patients fluids?
HHNS pts are more commonly hypernatremic:
0.9% saline solution 1L/hr for the first two hours, then switch to hypotonic solution 500 mL/hr for the next 4 hours, then 250 mL/hr thereafter.
What is the ideal insulin administration in a patient with DKA or HHNS?
Low-dose soluable (regular) insulin as a continuous IV infusion.
Starting dose 5-10 U/hr in DKA; 1-5 U/hr in HHNS.
What is the goal of insulin administration in a patient with DKA or HHNS?
A decrease of 75-90 mg/dL per hour until 250, then maintained at 2-4 U/hr and glucose infusion until the ketosis ad acidosi are resolved.
In a patient with DKA, does death usually occur from hypokalemia or hyperkalemia?
Hypokalemia
How do you replace potassium in a patient with DKA or HHNS?
20-30 mEq/hr unless hypokalemia present or biacabonate administered then 40-80 mEq/hr
True or False:
Routine use of bicarbonate in DKA is proven to speed the recovery of patients.
False: it can actually increase ketone production.
When do you consider bicarbonate treatment in patients with DKA?
only when they are in imminent danger of cardiovascular collapse (pH of less than 7)
Is replacement of phosphate and magnesium needed in DKA?
No, although plasma levels are low, replacement isn't needed unless phosphate levels are less than 1.5.
If a patient has phosphate levels <1.5, what do you do?
IV phosphate 1-2 mmol/L per kg during 6-12 hours.
What are five complications of the treatment of DKA and HHNS?
Fluid overload
Hypoglycemia
Thromboembolism
Cerebral Edema
ARDS
How do you administer insulin in acutely ill patients not on oral nutrition?
Regular insulin administered IV 0.5-5.0 U/hr by infusion pump
How do you administer insulin in hospitalized patients on oral nutrition?
Regular and intermediate-acting insulins are administered subcutaneously two to four times a day.