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6 Cards in this Set
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- Back
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DKA
why |
result of severe insulin insuf
and hyperglycemia in type 1DM may be initial presentation and can be precipitated by insuff or interrupted insulin Tx , infect stress MI alcohol drugs( steroids, thazide) metabolic acidosis and dehydration presenting with N/V abdominal pain kussmaul respiration ( sloe deep breathing) fruity odor acetone dehydration ( dry skin and mucosa membranes poor skin turgor mental status change) |
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DKA what will be on lab
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bllodglucose> 250
HCO#-< 15 AG>12 pH<7.30 ketones ( acetoacetate acetone hydroxy buterate) increase amylase/ lipase for unknown reason |
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DKX TX
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manage the volume status
initial step - volume restoration-- start IV NS bolus of 1-2 L and then maintain fluids manage hyperglycemia insulin 0.1 unit/kg of regular insulin IV- push then insulin drip at a rate 0.1 units/kg/ hour fingerstick are every hour when blood glucose , 250>>>chan ge IV to D5 containing ( D5W or D51/2 normal saline manage hypokalemia total body K is depleed even the on chem serum K is 7 ... if K is < 3.3 hold (stop!)insulin ( worsen hypokalemia and replace K until it reach > 3.3 KCL may be addeed to 1/2 normal saline ( creating the isotonic solution0 running at rate of 20-30 MEq of KCH/ hour if the srum K is (<=)5.3 manage the acidosis- add bicarb only if pH is < 7.10 ( this apply only to patient with DKA) check AG |
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hyperosmolar non ketonic coma
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predominantly in DM 2 type
severe hyperglycemia in the absense of ketosis precipitated by Tx non compliance inadequate water intake inf drugs diuretics phenytoin steroids and strokes common in old patients living in nursing homes the major problem is fatal dehydration from hyperglycemic diuresis causing weakness polyuria polydipsia lethargy confusion convulsion coma |
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hyperosmolar non ketonic coma ds
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neurologic abnormalities may progress to coma
hydreation hyperglycemia is usually > 600-1000 plasma osmolarity>330 ph <7.30 bicarb 20 mild metabolic non ketonic acidosis AG is normal |
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hyperosmolar non ketonic coma tx
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manage the volume status
initial step - volume restoration-- start IV NS bolus of 1-2 L and then maintain fluids manage hyperglycemia insulin 0.1 unit/kg of regular insulin IV- push then insulin drip at a rate 0.1 units/kg/ hour fingerstick are every hour when blood glucose , 250>>>chan ge IV to D5 containing ( D5W or D51/2 normal saline manage hypokalemia total body K is depleed even the on chem serum K is 7 ... if K is < 3.3 hold (stop!)insulin ( worsen hypokalemia and replace K until it reach > 3.3 KCL may be addeed to 1/2 normal saline ( creating the isotonic solution0 running at rate of 20-30 MEq of KCH/ hour if the srum K is (<=)5.3 manage the acidosis- add bicarb only if pH is < 7.10 ( this apply only to patient with DKA) check AG |
