So if you have a patient with either DKA or hyperosmolar you start with fluids
You give 0.9% and you can even give 1 liter per hour you can give 5-10 units of insulin rigth of way then you give insulin drip so the glucose goes down 50-75 mg/dl per hour also you give 10 meq of K bicarbonate or K cloride and then you give 0.45% SOLUTION when the glucose reach 250-300 you give dextrose 50% if the sodium is 150 you can change the solution to a D5%
WHEN do we change from 0.9% to 0.45% solution?
Is the abobe correct? you can add also thanks ___________________ As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
Eagle_303 Forum Guru
Topics: 77 Posts: 655
07/09/08 - 08:56 PM
#2
What we need to know that in DKA we give "FIL" i.e the patient is dehydrated you "FIL" it
Fluids -First N-saline then 1/2 N-saline
Insuline
Lytes i.e P= Potasseum ,P = Phosphate
Done
WaqasQureshi Forum Senior
Topics: 5 Posts: 178
07/25/08 - 05:49 PM
#3
do we give PHOSPHATE?????
WaqasQureshi Forum Senior
Topics: 5 Posts: 178
07/25/08 - 05:50 PM
#4
we change from 0.9 to 0.45 when we are done with the FLUID DEFICIT. How you calculate fluid deficit is LONG PROCEDURE I mean it involves maths and it wont be there on USMLE. So leave it. After that you start with 0.45 with D5W for maintainance
Eagle_303 Forum Guru
Topics: 77 Posts: 655
07/26/08 - 07:32 AM
#5
WaqasQureshi wrote: do we give PHOSPHATE?????
Hypophosphatemia like Hypokalemia (which are result of DKA therapy) are equally dangerous.
Eagle_303 Forum Guru
Topics: 77 Posts: 655
07/26/08 - 07:35 AM
#6
WaqasQureshi wrote: we change from 0.9 to 0.45 when we are done with the FLUID DEFICIT. How you calculate fluid deficit is LONG PROCEDURE I mean it involves maths and it wont be there on USMLE. So leave it. After that you start with 0.45 with D5W for maintainance
If the fluid deficit has been corrected then there is no need for further fluids.
You give N-saline as long as the pt is in shock,Once he is out you switch over to hypotonic therapy .Once fluid requirement is no more stop the fluids
I mean it involves maths and it wont be there on USMLE. So leave it. After that you start with 0.45 with D5W for maintainance