DKA & HHS - Dr. Johnston Flashcards
Clinical Presentation of DKA and HHS
- Polyuria
- Polydipsia
- Weight loss
- Vomiting
- Weakness
- Dehydration
Physical signs of DKA and HHS
- Poor skin turgor
- Tachycardia
- Hypotension
- Altered mental status
Are Kussmaul respirations seen in DKA or HHS
-DKA
Lab values seen in DKA patients
- Blood glucose > 250
- pH < 7.3
- Bicarb < 15
- Positive for Ketones
- Anion gap > 12
Lab values seen in HHS patients
- Blood glucose > 600
- pH > 7.3
- Bicarb > 15
- mOsm/kg > 320
Precipitating Factors
- Infection
- Inadequate insulin therapy
- Pancreatitis
- MI
- Alcohol abuse
- Drugs
IV Fluids
- LR
- NS
- 1/2 NS
Insulin bolus and continuous infusion dose
- 0.1 units/kg now
- 0.1 unitis/kg/hr
What do you do if the BG does not drop by at least 10% in the first hour
-Give a 0.14 unit/kg bolus then continue the insulin infusion
When to decrease insulin for DKA
- Blood glucose < 200
- Decrease infusion rate to 0.02 to 0.05 units/kg/hr
- Change fluids to D51/2NS
When to decrease insulin for HHS
- Blood glucose < 300
- Decrease infusion rate to 0.02 to 0.05 units/kg/hr
- Change fluids to D51/2NS
Patients with DKA should have their blood glucose maintained at what level?
- 150 to 200mg/dL
- Until DKA is resolved
Patients with HHS should have their blood glucose maintained at what level?
- 200 to 300mg/dL
- Until patient is mentally alert
When do you supplement a patient with K+
-If their K+ levels are < 3.3
-Give 20 to 30mEq/L
until > 3.3mEq/L
When do you give a patient Bicarb
-ONLY if their pH is < 6.9
