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Question 9
•All of the following are appropriate treatments for DKA EXCEPT
A.Administering normal saline in the first 4-6 h
B.Replacing the 3 to 5 mEq KCl/kg deficit gradually over the first 2-3 days
C.Infusing insulin at 0.1 U/kg/h after the initial bolus is given
D.Stopping insulin administration when glucose levels fall to 250 mg/dL
E.Administering phosphate if levels fall below 1.0 mg/dL
Answer & Comments
•D
Comments:
–Patients with DKA have an average water deficit of 5-10 % secondary to the osmotic diuresis that occurs with high serum glucose levels.
–Normal saline administration prevents a rapid fall in osmolality that could lead to excessive transfer of water into the central nervous system.
–Although the initial serum potassium level is elevated, repletion of potassium is necessary to restore low intra-cellular levels.
–To prevent hypoglycemia, dextrose should be added to intravenous fluids when the serum glucose falls to a level between 250 and 300 mg/dL.
–Even with this level of glucose, continued insulin is needed to resolve the acidosis and ketonemia.
–Phosphate levels only become critical when below 1.0 mg/dL.
•All of the following are appropriate treatments for DKA EXCEPT
A.Administering normal saline in the first 4-6 h
B.Replacing the 3 to 5 mEq KCl/kg deficit gradually over the first 2-3 days
C.Infusing insulin at 0.1 U/kg/h after the initial bolus is given
D.Stopping insulin administration when glucose levels fall to 250 mg/dL
E.Administering phosphate if levels fall below 1.0 mg/dL
Answer & Comments
•D
Comments:
–Patients with DKA have an average water deficit of 5-10 % secondary to the osmotic diuresis that occurs with high serum glucose levels.
–Normal saline administration prevents a rapid fall in osmolality that could lead to excessive transfer of water into the central nervous system.
–Although the initial serum potassium level is elevated, repletion of potassium is necessary to restore low intra-cellular levels.
–To prevent hypoglycemia, dextrose should be added to intravenous fluids when the serum glucose falls to a level between 250 and 300 mg/dL.
–Even with this level of glucose, continued insulin is needed to resolve the acidosis and ketonemia.
–Phosphate levels only become critical when below 1.0 mg/dL.
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