Morning Report: 1/14/2014

Today’s Morning Report is presented by Dr. Aldokhi!

 

AKA versus DKA

AKA DKA
–        Alcoholic

–        Underlying disease

–        Missed Etoh

–        Diabetic

–        Underlying disease

–        Missed insulin

Nausea , vomiting, abdominal pain Nausea , vomiting, abdominal pain
DIAGNOSIS

–        Hx + Ex

–        High AG

–        Ketoneuria, ketonemia

–        ? Glucose

DIAGNOSIS

–        Hx + Ex

–        pH <7.3

–        AG >12

–        Glucose >250

–        Ketoneuria, ketonemia

Rx

–        Thiamine 100 mg

–        IV Fluid

–        Glucose

–        Potassium

–        Mg

–        phosphorus

Rx

–        Insulin 0.1 /kg bolus then 0.1/kg/hr or intermittent rapid acting *

–        IV fluid

–        Potassium

 

IV fluid

–        Dextrose

–        Saline

IV fluid

–        NS initially 1L/hr

–        If low Na continue NS

–        If normal or high Na start 0.45 NS

 

Insulin in DKA

Type of Insulin

Brand Name

Generic Name

Onset

Peak

Duration

*Rapid-acting

 NovoLog  Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
 Apidra  Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
 Humalog  Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours

 

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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