uscitation clears ketones and other by-products of DKA. It a
Fluid resuscitation clears ketones and other
by-products of DKA. It also restores normal IV FLUIDS
blood and corrects
electrolyte imbalances timesofamerica.info The patient’s serum
sodium levels need to be checked to determine which type of fluid they need.
INSULIN
Insulin is the mainstay
therapy for DKA. v It promotes cellular utilization of glucose, which immediately
decreases blood ketone and glucose concentrations.
Before giving insulin to
DKA patients, however, you need to check the patient’s potassium levels because
insuli
timevinger.org n leads to intracellular shifts in potassium. Patients with DKA can have
normal or elevate
tincona.com d blood potassium even with decreased potassium stores. This
is a result of osmotic diuresis and transcellular fluid shifts.
If blood potassium
levels are less than 3.3 mEq/L, you need to replete potassium before giving
insulin therapy.
The rate of insulin
therapy will depend on patient age, the presence of insulin sensitivity, and
the severity of DKA.
When blood glucose
concentrations fall below 250mg/dl, adding 5% dextrose will prevent
hypoglycemia. This will help continue insulin therapy until acidosis is
resolved. Use up to 20% dextrose concentration if you are unable to prevent
hypoglycemia.
ELECTROLYTES
Besides correcting potassium imbalances, you may need to ensure the patient’s blood magnesium concentration is over 2 mg/dl. Magnesium is a cofactor in cellular potassium uptake, and low levels can lead to refractory hypokal
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