5/2/1 – 50! IV dextrose for hypoglycemia
There is a quick memory aid that will help you remember how much dextrose to give to patients with hypoglycemia.
Podcast Briefs: Stress Dose Steroids
Your time is valuable and so is mine. That's why I'm sharing brief, focused podcast episodes that will hone in on a single problem. This time, it's stress dose steroids. Learn about how to give them and to not worry about tons of body surface area related math when you have a sick child in front of you.
Assessing for cerebral edema in DKA
Adapted from Muir et al, Diabetes Care, 2004 here is a protocol/schema that can guide in the assessment of cerebral edema in DKA. Recall that the symptoms of cerebral edema vary, and it can be especially difficult to diagnose as findings will occur ahead of CT/MRi changes. One-half to 1% of patients in DKA have cerebral edema, the mortality of [...]
The two bag system for fluid administration in DKA
Did you know that hospital waste an incredible number of IV fluid bags every year? One of the most significant occurrences of the aforementioned waste is in DKA, where frequent changes to the dextrose concentration are needed as the acidosis is corrected with an insulin infusion. Instead of changing to a new bag each time you want to alter the [...]
Briefs: Gimme a D! Gimme a K! Gimme an A! What’s that spell?
Here's a quick review of the general management principles for DKA. Fill the tank This begins with a 10ml/kg 0.9%NS bolus. This accomplishes the following: Restores circulation Increases glucose uptake in the periphery Increases glomerular filtration Reverses the mounting acidosis In many cases blood glucose rapidly declines following initial fluid resuscitation. Once you've improved perfusion, then start 0.45% saline for maintenance and replacement . [...]
