Assessment & Plan (short)
# Diabetic Ketoacidosis
Patient presents with malaise, polydipsea and polyuria, found to have significant hyperglycemia. pH ***, AG ***, BHB ***, UA with Ketones. Last A1c ***. Suspect trigger is ***. No history of heart failure or evidence of volume overload.
Dx
- tele/CPO
- CBC, CMP, VBG, BHB, UA, Utox
- CXR, BCx x2
- q1-2hr Na, K, glucose checks per DKA protocol
- Troponin if chest discomfort
- A1c
Tx
- DKA protocol, s/p 10u IV regular (0.1U/kg), then insulin gtt
- IVF: *** (LR preferred; 1L/hr x 4h; 250-500cc/hr x 4h; 100-250cc/hr)
- Hold insulin for K<3.3
Assessment & Plan (long)
# Diabetic Ketoacidosis
Patient presents with malaise, polydipsea and polyuria, found to have significant hyperglycemia. pH ***, AG ***, BHB ***, UA with Ketones. Last A1c ***. Suspect trigger ***med inadherence, as pt without infectious symptoms and low concern for stroke or MI. No history of heart failure or evidence of volume overload.
Dx
- tele/CPO
- ICU for pH<7.1, access issues, hypotension, oliguria, AMS
- CBC, CMP, VBG, BHB, UA, Utox
- CXR, BCx x2
- q1-2hr Na, K, glucose checks per DKA protocol
- Troponin if chest discomfort
- A1c
Tx
- Access: ***
- hold insulin for K<3.3; supplement 20-30mEq/1L IVF for K 3.3-5.3)
- DKA protocol, s/p 10u IV regular (0.1U/kg), then insulin 5u/hr gtt
- NaHCO3 for pH<7
- IVF: *** (LR preferred; 1L/hr x 4h; 250-500cc/hr x 4h; 100-250cc/hr)
- Holding Home insulin regimen: ***
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Originally created: March 3, 2020 by Eric Lee
Last updated on July 8, 2020 by Eric LeePage Editor: not assigned
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