While bolus insulin is common in the treatment of DKA in adults, it is relatively contraindicated in the pediatric patient. Dehydration and secondary sympathetic activation can interfere with local tissue perfusion and may cause irregular and unpredictable absorption.
Herein, can lispro be given IV?
Insulin lispro-aabc 100 units/mL can be administered intravenously under medical supervision with close monitoring of blood glucose and potassium concentrations to avoid hypoglycemia and hypokalemia.
Moreover, how do pediatrics manage DKA?
Key points. Treatment of DKA requires first and foremost fluid resuscitation with 0.9% saline, followed by replacement for 5%–10% dehydration, depending on severity, and maintenance with 0.45% saline, and early and adequate K replacement.
How do you calculate fluid deficit in pediatrics DKA?
For most children, use
| Weight | |
|---|---|
| >60kg | 35 ml/kg/24 hrs |
How do you titrate insulin drip?
D50 Protocol
- Hold insulin drip.
- BG 41-70: Give 1/3 amp D50 IV.
- BG ≤ 40: Give 1 amp D50 IV.
- Repeat BG q15m until BG >70 mg/dL. Check q30 until BG >110 mg/dL.
- Once BG >110 mg/dL, check BG hourly and restart infusion at 1/2 prior rate once BG >180 mg/dL.
What fluids do you run with insulin drip?
“Generally, we use normal saline or lactated Ringer’s as a first choice for IV fluid, at a rate of approximately 1 liter an hour for the first 4 hours, and this may be adjusted for patients who are at risk for volume overload, such as elders or patients with chronic kidney disease or congestive heart failure,” she said …
What is the anion gap for DKA?
In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L.
What is the sliding scale for insulin?
The term “sliding scale” refers to the progressive increase in pre-meal or nighttime insulin doses. The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements.
What is the two bag method DKA?
Background: The “two-bag method” of management of diabetic ketoacidosis (DKA) allows for titration of dextrose delivery by adjusting the infusions of two i.v. fluid bags of varying dextrose concentrations while keeping fluid, electrolyte, and insulin infusion rates constant.
What IV solution is used for diabetic ketoacidosis?
The initial priority in the treatment of diabetic ketoacidosis is the restoration of extra-cellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution.
When do you give Lantus to DKA?
A dose of glargine (Lantus®) is given subcutaneously after resolution of the DKA (i.e. when the intravenous insulin is stopped). This is currently the standard-of-care practice for children in DKA.
When should insulin drip be stopped?
DKA is resolved when 1) plasma glucose is <200–250 mg/dL; 2) serum bicarbonate concentration is ≥15 mEq/L; 3) venous blood pH is >7.3; and 4) anion gap is ≤12. In general, resolution of hyperglycemia, normalization of bicarbonate level, and closure of anion gap is sufficient to stop insulin infusion.
Why do we give fluids before insulin in DKA?
Fluid administration in the first hour of therapy before insulin administration has the following advantages: 1) it allows time to obtain a serum potassium level on presentation, 2) it corrects hypotension, which may increase if insulin is used without hydration, 3) it improves insulin action and may reduce the …
Why is D5W given with insulin?
Add 5% dextrose in water (D5W) when serum glucose levels reach 14 mmol/L in DKA so that insulin can be continued to achieve ketone clearance.