Initial Management
DKA diagnosis criteria (4)
What is glucose >250, anion gap >12, bicarb < 18?
(pH<7.3, moderate ketonuria or ketonemia)
Replace K+ in DKA when it is lower than
What is 5.3 mmol/L with adequate urine output?
When to start SubQ insulin in DKA
What is 2 hours prior to discontinuing insulin IV?
Mental status associated with HHS patients
What is stupor/coma?
HHS diagnostic criteria (4)
What is glucose >600, pH >7.3, bicarb >15, minimal ketonuira and ketonemia
Hold insulin initiation until you correct K+ when it is below
What is <3.3?
DKA- Goal blood sugar range while correcting acidosis
What is 150-200?
Mental status associated with DKA
What is alert/drowsy?
Common causes of DKA
What are infections, non-compliance, inappropriate adjustment/cessation of insulin, new onset, myocardial ischemia
While correcting acidosis add dextrose IVF when the glucose is __
What is 300mg/dL?
Best way to determine insulin requirement in a patient of DKA
What is 24 hours of IV insulin therapy?
HHS- goal blood sugar until patient is mentally alert
What is 200-300mg/dL?
First step in treating a patient with DKA or HHS
What is isotonic fluids?
DKA- add this if pH <6.9
(repeat q3 hours until pH>7)
DKA weight based insulin rate
What is 0.1 units/kg/hr?
Reason we don't stop insulin until gap is closed and basal insulin on board, regardless of blood sugars
What is suppression of ketone production?
Deep and labored breathing pattern often associated with metabolic acidosis
What is Kussmaul's respiration?
DKA- Frequency of BMP, venous pH, creatinine
What is 2-4 hours?
Next step if the blood glucose does not fall by at least 50mg/dL in 1st hour.
What is increase the insulin rate from 0.1unit/kg/hr to 0.15 units/kg/hr?
Half-life of IV insulin
What is 7-10 minutes?