IV 8oute
&C I( 8oute
)*#o+olemic &!oc'
(ild )*#otention
Cardio%enic &!oc'
If initial serum 3. is B ?.? m-6 L9 !old insulin and %i+e 00 m-6 3. #er C! (5 ? 3CL and 1 ? 3P="9 until 3 D ?.? m-6 L
#) B @.9
#) E :.0
)emo monitorin%
d*namic
No )C=?
If initial serum 3. is D ?.? but B 1.0 m-6 L9 %i+e 502 ?0 m-6 3. in eac! liter of IV fluid (5 ? 3CL and 1 ? 3P="9 to 'ee# serum 3. at 021 m-6 L
&erum Na !i%!
&erum Na Normal
&erum Na Lo/
;i+e !ourl* IV insulin infusion bolus (10 units" until %lucose falls b* 102:0 m% dl
C!an%e to 1% de$trose /it! 0.01% NaCl at 1102510 ml ! /it! ade6uate insulin (0.0120.1 units 3%21.!21 IV infusion or 1210 units &C e+er* 5!" to 'ee# t!e serum %lucose bet/een 110 and 500 m% dl until metabolic control is ac!ie+ed.
C!ec' electrol*tes9 B<N9 creatinine and %lucose e+er* 520!9 until stable. After resolution of ,3A9 if t!e #atient is NP=9 continue IV insulin and su##lement /it! &C re%ular insulin as needed. 4!en t!e #atient can eat9 multi#le dos sc!edule s!ould be started t!at uses combination of s!ort or ra#id actin% and intermediate or lon% actin% insulin as needed to control #lasma %lu'ose. Initiate &C insulin 0.1 > 1.0 u.3% 21. d21 %i+en as 5 ? a.m9 1 ? in #m or as 0.1 > 0.51 unit.'% re%ular e+er* @2 A !ours durin% t!e first 50 !ours for ne/ #atients to determine re6uirement. Continue IV insulin influssion for 1+, h after SC insulin as .egun to ensure ade/uate plasma insulin level" Continue to loo0 for pre1ipitating 1auses )s-
Management of adult Patient with 22s Com#lete Initial e+aluation9 &tart IV fluids 7 1.0 L of 0.9% NaCl #er !our Initiall*
IV Fluida Insulin Potassium
)*#o+olemic &!oc'
(ild )*#otention
Cardio%enic &!oc'
If initial serum 3. is B ?.? m-6 L9 !old insulin and %i+e 00 m-6 3. #er C! (5 ? 3CL and 1 ? 3P="9 until 3 D ?.? m-6 L
)emo monitorin%
d*namic
C!ec' serum %lucose !ourl*9 If serum %lucose does not fail b* 102:0 m% dl in first !our
If initial serum 3. is D ?.? but B 1.0 m-6 L9 %i+e 502 ?0 m-6 3. in eac! liter of IV fluid (5 ? 3CL and 1 ? 3P="9 to 'ee# serum 3. at 021 m-6 L
&erum Na !i%!
&erum Na Normal
&erum Na Lo/
C!an%e to 1% de$trose /it! 0.01% NaCl and decreased insulin to0.0120.1 units 3%21.!21 IV infusion to 'ee# t!e serum %lucose bet/een 510 and ?00 m% dl until #lasma osmolalit* is G ?11 m=sm '% and #atient mentall* alert.
C!ec' electrol*tes9 B<N9 creatinine and %lucose e+er* 520!9 until stable. After resolution of ,3A9 if t!e #atient is NP=9 continue IV insulin and su##lement /it! &C re%ular insulin as needed. 4!en t!e #atient can eat9 multi#le dos sc!edule s!ould be started t!at uses combination of s!ort or ra#id actin% and intermediate or lon% actin% insulin as needed to control #lasma %lu'ose. Initiate &C insulin 0.1 > 1.0 u.3% 21. d21 %i+en as 5 ? a.m9 1 ? in #m or as 0.1 > 0.51 unit.'% re%ular e+er* @2 A !ours durin% t!e first 50 !ours for ne/ #atients to determine re6uirement. Continue IV insulin influssion for 125 ! after &C insulin as be%un to ensure ade6uate #lasma insulin le+el. Continue to loo' for #reci#itatin% causes (s"