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