Lytes Flashcards
Who are DKA and HHS usually seen in?
- DKA: younger patients 2/ T1D
2. HHS: older patients w/ poorly controlled TIIDM
Presentation DKA?
- Absolute insulin deficiency
- Hyperglycemia
- Anion gap acidosis
- Dehydration
How to replace fluids in DKA/HHS?
- Start w/ isotonic saline at 15-20 ml/kg per hou4
- Switch to 1/2 isotonic saline when the Na normalizes
- Add dextrose when glucose reaches 250 mg/dL
How to add insulin in DKA/HHS?
- Start with an infusion of regular insulin at 0.1 U/kg/hr
2. Double dose of insulin if glucose does not fall by 50-70 mg/dL in first hour
How to handle K replacement in DKA/HHS?
- If initial K under 3.3, DELAY insulin therapy until fluid and potassium replacement
- Administer K w/ initial IVF if potassium levels are normal or low and maintained between 4 – 5
Glucose and lytes monitoring in DKA/HHS?
- Glucose every hour until stable, then every 2 – 4
2. BMP and blood pH every 2 – 4 until stablization
Typical presentation HYPOglycemia?
- AMS
- Tachycardia
- Diaphoresis
Preferred method glucose admin in HYPOglycemia?
- Oral: 300g/1200cal of carbs (soda, juice, sandwich, snacks), complex carbohydrates will be better at maintaining blood glucose levels
- In adults start with 50 ml of 50% Dextrose in Water (D50). In pediatric patients use 1 ml/kg of 25% Dextrose in water or 2-4 ml/kg of 10% Dextrose in water
What needs to be given to alcoholics with glucose?
Thiamine to prevent wernicke encephalopathy
When to use glucagon in HYPOglycemia?
When theres no IV access. In adults administer 1 mg IM and 0.5 mg in pediatric patients < 20 kg . I
When is octreotide useful in HYPOglycemia?
May be useful in the setting of sulfonylurea-induced hypoglycemia not responsive to other therapies
Most common trigger thyroid storm?
Infection
Triad thyroid storm?
- Fever
- AMS
- Tachycardia
