DKA and crashing asthma

Question 1

What is the antibody that is specific for DM I?

Answer 1

Anti-GAD

Question 2

When do you switch over to 0.45 NS in the treatment of DKA? D5,0.45 NS?

Answer 2

• Once near normalization of fluid status (urine output, BP/mentation improves)
• Add D5 once BG less than 250

Question 3

If the pH of anion gap does not improve, what two things must be considered?

Answer 3

• Insulin prep wrong

- Infection

Question 4

What are the K cutoffs for beginning treatment for DKA?

Answer 4

• If over 5, just start
• If [3.3, 5], ive 20-30 mEq/L in IVFs
• If less than 3.3, hold insulin, give 40 mEq/hr

Question 5

What is the max dose of K in a peripheral line? Central?

Answer 5

• peripheral = 10 mEq/hr

- Central = 20 mEq/hr

Question 6

What is the major downside of giving bicarb in DKA?

Answer 6

Paradoxical CNS acidosis

Question 7

When is bicarb indicated for DKA?

Answer 7

If pH less than 6.9

Question 8

When should hypophosphatemia be treated?

Answer 8

If less than 1.0 mg/dL, or symptomatic (muscle weakness, rhabdo)

Question 9

How do you treat hypophosphatemia?

Answer 9

• Giving Kphos,

- Monitor Ca levels

Question 10

What must be monitored with giving k-phos?

Answer 10

Ca levels

Question 11

What are the resolution criteria for DKA resolution in terms of pH, bicarb, BG?

Answer 11

• BG less than 200
• Bicarb over 18
• pH over 7.3

Question 12

What is the equation for determining insulin dose in a new onset DKA patient?

Answer 12

0. 5 units/kg/24 h
   - half as long acting basal dose
   - half as fast acting mealtime doses (with 20% of TDD before each meal)

Question 13

What is the dose and rate of IVFs for pediatric DKA?

Answer 13

-10 cc/kg over 1 hour, max 500 cc

then

-Insulin drip + maintenance

Question 14

What are the PaO2, PaCO2, and PEF for severe asthma?

Answer 14

• PaO2 less than 60 mmHg
• PaCO2 over 42
• PEF less than 50% predicted

Question 15

What is the dose and frequency for atrovent (ipratropium)?

Answer 15

250 mcg q 20 minutes x3

Question 16

What is the dose of solu medrol for severe asthma exacerbation?

Answer 16

1-2 mg/kg IV

Question 17

What is the role of inhaled steroids in the treatment of severe asthma exacerbations?

Answer 17

Can use in addition to IV, but IV is first

Question 18

What is the max oxygen sat you can give with NC? Non-rebreather?

Answer 18

NC = ~25%
Non-rebreather = ~60%

Question 19

What is the acceptable oxygen amount for a severe asthma exacerbation?

Answer 19

88-92%

Question 20

What is the dose of terbutaline for severe asthma exacerbations?

Answer 20

0.1 mg sq or 0.1/mcg/kg IV

Question 21

What is the dose and rate of IV mg for asthma?

Answer 21

2-4 grams over 10 minutes

Question 22

What is the max end inspiratory flow pressure for an intubated asthmatic?

Answer 22

35 cm H2O

Question 23

What is the max plateau pressure (PEEPi) for an intubated asthmatic?

Answer 23

15 cm H2O

Question 24

What is the inspiratory flow rate for an intubated asthmatic?

Answer 24

50-100 LPM

Question 25

What is the RR for an intubated asthmatic patient?

Answer 25

6-8

Question 26

What is the paralytic of choice for crashing asthmatics for intubation? Why?

Answer 26

Succ since steroids + long acting paralytic = significant myopathy

Question 27

What are the goal SaO2, and pH for an intubated asthmatic?

Answer 27

SaO2 = 88%

PaCO2 can rise as long as pH stays above 7.2