Fluids/ DKA

Question 1

Generally what is the maximum amount of fluid one can give a sick patient

Answer 1

2L

Question 2

What type of “sweet” fluid should be given as maintenance

Answer 2

Glucose 5percent/ potassium 0.3percent

1L over 8-12h

Question 3

Types of maintenance fluids

Answer 3

2 sweet + 1 salty

5percent dextrose + saline
Add 20mmol KCL to each pack over 8h

Question 4

Hypoglycaemia fluid

Answer 4

Glucose 10percent, 100ml

10g glucose

Question 5

Maximum rate of K infusion per hour

Answer 5

10mmol/hour

Question 6

How much is 1percent solution

Answer 6

1g in 100ml

Question 7

Immediate treatment of DKA

Answer 7

500 mL saline IV over 10–15 minutes

Question 8

How much insulin to give in DKA

Answer 8

insulin + saline IV 1 unit/mL

infuse at a fixed rate of 0.1 units/kg/h

Question 9

When to give glucose in DKA + how much

Answer 9

Once BM <14

10percent glucose IV

infused at rate of 125ml/h

Question 10

When to stop insulin infusion in DKA

Answer 10

When
Ketones <0.3
pH >7.3
Patient taking orally

(Give fast acting insulin with meal then stop infusion 1h later)

Question 11

Best way to check if DKA has resolves

Answer 11

Ketones

Question 12

How many mmol Na is in a 1L bag of normal saline

Answer 12

154

Question 13

Some patients should not receive the usual 2 sweet + 1 salty maintenance fluids.

Which patients? What maintenance fluids to give them?

Answer 13

Stroke patients (avoid glucose due to increased risk of cerebral oedema)

Give 3 bags of 1L normal saline with 20mmol potassium

Question 14

When should Hartmann’s solution not be used

Answer 14

Hyperkalemia