DKA and crashing asthma Flashcards
What is the antibody that is specific for DM I?
Anti-GAD
When do you switch over to 0.45 NS in the treatment of DKA? D5,0.45 NS?
- Once near normalization of fluid status (urine output, BP/mentation improves)
- Add D5 once BG less than 250
If the pH of anion gap does not improve, what two things must be considered?
- Insulin prep wrong
- Infection
What are the K cutoffs for beginning treatment for DKA?
- 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
What is the max dose of K in a peripheral line? Central?
- peripheral = 10 mEq/hr
- Central = 20 mEq/hr
What is the major downside of giving bicarb in DKA?
Paradoxical CNS acidosis
When is bicarb indicated for DKA?
If pH less than 6.9
When should hypophosphatemia be treated?
If less than 1.0 mg/dL, or symptomatic (muscle weakness, rhabdo)
How do you treat hypophosphatemia?
- Giving Kphos,
- Monitor Ca levels
What must be monitored with giving k-phos?
Ca levels
What are the resolution criteria for DKA resolution in terms of pH, bicarb, BG?
- BG less than 200
- Bicarb over 18
- pH over 7.3
What is the equation for determining insulin dose in a new onset DKA patient?
- 5 units/kg/24 h
- half as long acting basal dose
- half as fast acting mealtime doses (with 20% of TDD before each meal)
What is the dose and rate of IVFs for pediatric DKA?
-10 cc/kg over 1 hour, max 500 cc
then
-Insulin drip + maintenance
What are the PaO2, PaCO2, and PEF for severe asthma?
- PaO2 less than 60 mmHg
- PaCO2 over 42
- PEF less than 50% predicted
What is the dose and frequency for atrovent (ipratropium)?
250 mcg q 20 minutes x3
What is the dose of solu medrol for severe asthma exacerbation?
1-2 mg/kg IV
What is the role of inhaled steroids in the treatment of severe asthma exacerbations?
Can use in addition to IV, but IV is first
What is the max oxygen sat you can give with NC? Non-rebreather?
NC = ~25% Non-rebreather = ~60%
What is the acceptable oxygen amount for a severe asthma exacerbation?
88-92%
What is the dose of terbutaline for severe asthma exacerbations?
0.1 mg sq or 0.1/mcg/kg IV
What is the dose and rate of IV mg for asthma?
2-4 grams over 10 minutes
What is the max end inspiratory flow pressure for an intubated asthmatic?
35 cm H2O
What is the max plateau pressure (PEEPi) for an intubated asthmatic?
15 cm H2O
What is the inspiratory flow rate for an intubated asthmatic?
50-100 LPM
What is the RR for an intubated asthmatic patient?
6-8
What is the paralytic of choice for crashing asthmatics for intubation? Why?
Succ since steroids + long acting paralytic = significant myopathy
What are the goal SaO2, and pH for an intubated asthmatic?
SaO2 = 88%
PaCO2 can rise as long as pH stays above 7.2
