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1. Orders:
1. imp: DKA
2. ACT: CBR
3. Vital signs: close observation
4. Diet: NPO
5. Condition: urgent
6. IV line 2* fix
7. CVS q1h
8. ECG
9. POM & CHM
10. O2 therapy if SpO2<94%
11. internal folly fix + check intake & output
12. Check
1. CBC, diff
2. Na, K, Ca, P, Mg
3. VBG, ABG
4. U/A, U/C, BUN, Cr
5. BS, HbA1c
6. C-Peptide
7. TSH, T3, T4
8. ANTI-TTG IgA
9. CRP, ESR,
10. ALP
11. B/C
13. Check BS q1h
14. check VBG q2h
15. Check k q4h
16. Check Na, K, Mg, Ca, P, BUN q4h
17. IV hydration
1. start with serum N/S 10-20 cc/kg IV infusion in 1 hours, repeat if diuresis was not started (distract it from the whole fluid that should be given)
2. start 1000/10kh + 50/20 kg+ 20/kg cc IV maintenance
3. add deficit: 10cc*w*10-7%
18. Potassium
1. k<3.2 : 80meq/lit kcl
2. 3.2<k<4.5: 40meq/lit kcl
3. 4.5<k<5.5: 20meq/lit kcl
4. k>5.5: no KCl added
19. Insulin
1. only start when k>3.3
2. Serum HS 500cc + 0.1 unit/kg regular insulin ?cc/hr IV infusion
3. after resolving DKA, start insulin with 1unit/kg/day (1/3 basal, 2/3 regular) SQ with 30 minutes at least overlap with IV insulin
20. HCO3
1. if pH<6.9
2. NaHCO3 (100mmol) in 400cc/2hr H2O + 20meq KCl IV infusion
21. if + Headache, refractory vomiting, decreased LOC (in favor of brain edema)
1. Mannitol 1gr/kg/15min, repeat 30 mins later if no response seen
2. Types of fluids:
1. start hydration with N/S
2. give insulin in HS
3. BS<250 mg/dl ⇒ HS + DW5%
4. 150<BS<200 ⇒ HS + DW7.5%
5. 100<BS<150 ⇒ HS + DW10% + insulin 1/2
6. BS<100 ⇒ HS + DW12.5% + insulin 1/2
3. DKA criteria
1. BS>200
2. VBG: pH<7.3, HCO3<15
3. BHOP>3
4. Ketonuria
4. Resolved DKA criteria
1. pH>7.3
2. HCO3> 15
5. Goal of BS:
1. children: 150-180 mg/dl
2. adult: 100-150 mg/dl
6.
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