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Monitoring
Adult DKA
Check the patient’s glucose, blood urea nitrogen
(BUN), creatinine, and electrolytes every 2-4 hours until the patient is stable.
Continue to investigate the precipitating causes and treat them appropriately.
The criteria for resolution of diabetic ketoacidosis
include a blood glucose of <11.1 mmol/L (<200 mg/dL) and any of the
following: Venous pH of >7.3, bicarbonate of ≥15 mEq/L or calculated anion
gap of ≤12 mEq/L.
After the resolution of DKA, if the
patient is placed on nothing by mouth or non per os (NPO), continue intravenous
Insulin and supplement with subcutaneous Regular Insulin as required every 4
hours.
Once the patient is able to eat, start a multidose
insulin regimen and adjust as required. Intravenous insulin should be continued
for 1-2 hours after subcutaneous insulin is started.
Adult HHS
Check the patient’s blood urea nitrogen, creatinine,
electrolytes, and glucose every 2-4 hours until stable. Continue to investigate
the precipitating causes and treat them appropriately.
After the resolution of the hyperosmolar
hyperglycemic state, if the patient is still on NPO, continue the intravenous Insulin
and supplement with subcutaneous Insulin as required.
Once the patient is able to eat, start a multidose
insulin regimen (such as subcutaneous), or give as previous treatment and check
the metabolic control.
Pediatric DKA and HHS
Check glucose and electrolytes every 2-4 hours until
stable. Continue to investigate precipitating causes and treat them appropriately.
After the resolution of diabetic ketoacidosis, start
subcutaneous insulin (0.5-1 U/kg/day). Give 2/3 of the total daily dose in the morning
(AM) (1/3 short-acting and 2/3 of dose intermediate-acting insulin). Give 1/3
of the total daily dose in the afternoon (PM) (1/2 short-acting and 1/2 of dose
intermediate-acting insulin). Or give 0.1-0.25 U/kg of subcutaneous Regular
insulin every 6-8 hours for the first 24 hours to determine insulin
requirements.