doyoudig
Forum Guru
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Steps
1. Rapid Infusion of IV Nl Saline
2. IV Regular Insulin at continuous small doses
3. K once levels are 5 or <
so B is wrong -- b/c they give NPH as the option vs Reular Insulin
so is ans C -wrong
we do not see ketones in urine w/ HOONK -- this is definetly DKA
u do not wait for labs to give insulin, that's why in DKA we do a fingerprick test which is fast way to deterimne Glucose levels but we will Give IV Saline, Insulin and then look at labs to determine K levels to see when to add K......
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| doyoudig
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wanna make a correction
answers is indeed --> DDD
u 1st start w/ Rehydration w/ 0.9% NS -- but not wide open fluids usually at 7../kg/hr
2nd us get ur labs to know electrolyte abn to confrim DKA as well as check K levels before initiating Insulin
K is usally added if below < 5.5 I believe (so it would be given before starting insulin if its levels are low) if not then start Insulin therapy and monitor labs
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| genbot
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The question says the patient's urine has a low specific gravity, there is no mention of any signs of dehydration. It only says the patient is hypotensive.
What if the patient had a myocardial infarction which precipitated the DKA, would u still want to drown this patient in IV fluids ???
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| doc_clotaire
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[left]ANSWER IS : D
This patient is obviously in D.K.A. as evidenced by high serum glucose, glucosuria and ketonuria. What ones needs to do now is to resusciate the patient with FLUIDS! To reverse the ketone production that is contributing to the acidosis the patient also needs insulin BUT initially this is secondary to fluid resusciation. You do not want to be giving insulin to any patient without documented electrolytes. With the acidosis and dehydration, patients become potassium depleted. The committment acidosis will contribute to "shifting" potassium out of the cell giving you a falsely elevated potassium. The danger is if a patient is severly potassium depleted in the face of an acidosis, with the fluids correcting the acidosis, the insulin is going to shove more potassium into the cells thus acutely lowering the serum potassium level to potentially dangerous levels. If the potassium gets lower than 2.0-2.5 one is prone to provoking lethal arrhythmias.
I agree with you that A is a good option but Remember , in the boards we MUST pick the BEST ONE
In this case , After giving the patient FLUIDS , you must wait for the LAB and observe before giving him insulin .
[/left]
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