HYPERGLYCEMIA Flashcards
Considerations for the Critically Ill Hyperglycemic Patient
CIRCULATION
Patients may show signs of significant volume depletion. In adults, administer 1-2 liters of isotonic crystalloid to restore adequate perfusion and blood pressure
For pediatric patients, administer 10-20 mL/kg of isotonic crystalloid (use caution to avoid over-hydrating pediatric DKA patients).
DISABILITY/EXPOSURE
Evaluate for signs of an inciting illness such as Fournier’s gangrene or diabetic foot infection that may have gone unnoticed in the patient.
DDx
R/O
DKA
HHS
Sepsis
What are glucose targets
Lowering a patient’s plasma glucose below a certain threshold prior to discharge has not been shown to affect short-term outcomes.
Clinical Features
Range from Asymptomatic
to
polyuria, polydipsia, polyphagia, weight loss, and blurred vision.
to
critically ill
Investigations
CBC
Lytes
Extended Lytes
Urea
Creatinine
+/-Serum Ketones
+/-VBG
+/-Troponin
+/- ECG
+/-Urine Ketones
Other tests as indicated
Management: Severe Hyperglycemia (>33.3 mmol/L)
Adults:
1-2 L IV crystalloid bolus (will be dehydrated)
Pediatrics:
10-20 ml/kg crystalloid bolus (will be dehydrated)
Fluid resuscitation alone may normalize glucose if no other etiology responsible for elevated glucose
IF persistently hyperglycemic:
Insulin Regular 0.1 U / kg bolus IV or SQ
OR
0.1 U / kg / hr IV infusion
Management: Moderate Hyperglycemia (11.1-33.3 mmol/L)
No Medical Therapy may be necessary.
Treatment as clinically indicated.
Adults:
1-2 L IV crystalloid bolus (will be dehydrated)
Pediatrics:
10-20 ml/kg crystalloid bolus (will be dehydrated)
Fluid resuscitation alone may normalize glucose if no other etiology responsible for elevated glucose
IF persistently hyperglycemic:
Insulin Regular 0.1 U / kg bolus IV or SQ
OR
0.1 U / kg / hr IV infusion
Management: Mild Hyperglycemia (<11.1 mmol/L)
No treatment
