DKA
Early signs of DKA
Polyuria, polydipsia, Kussmaul respirations, fruity breath, fatigue, nausea & vomitting
What lab is most elevated in patients with HHS?
What is blood glucose levels often reaching > 600 mg/dL.
What needs to be done before turning off an insulin infusion?
What is, give Sub Q insulin 2 hours before turning off the insulin infusion?
This lab value confirms the resolution of DKA more accurately than blood glucose
What is, closure of anion gap?
What are common triggers for HHS?
What is infection, poorly controlled type 2 diabetes, steroids, trauma, surgery, and poor oral intake
What significant DKA lab(s) or hemodynamic abnormalities require ICU admission?
What is, a bicarb <10, Acidosis, Respiratory Distress, hypotension, altered mental status.
Describe the basic pathophysiology of DKA
what is the most important initial intervention in HHS?
What is aggressive IV fluid administration due to high fluid volume loss.
What is Cerebral edema?
A PaCO2 of 25 mmHg in a DKA patient reflects this physiologic response?
What is respiratory compensation?
Unlike DKA, HHS does not present with this initial metabolic finding
What is, Ketosis?
What is the goal rate of decreasing blood glucose within an hour?
What is 50-75 mg/dL per hour?
A patient’s glucose is 240 mg/dL, anion gap is still elevated, and potassium is 3.8. The priority nursing action is?
What is switch to D5W and NaCL 0.45% infusion if blood glucose < 250 mg/dL.
Describe the basic pathophysiology of HHS?
What is, a small amount of insulin is present- persistent hyperglycemia- osmotic diuresis- severe dehydration- leads to neurological dysfunction, electrolyte abnormalities, hypotension, tachycardia etc.
ICU Insulin Infusion order set VS DKA/HHS insulin Infusion order set
The ICU insulin infusion order set requires only a TKO fluid order and is units/hr, whereas the DKA/HHS insulin infusion order set is units/kg/hr and requires either 0.45% naCL at a rate of 125 mL/hr or D5W & 0.45% once blood glucose , 250 and titrated per hourly BS.