Fluid replacement : |
|
 |
give 2 litres of isotonic saline ( 0.15 mol/l ) over the first 4 h |
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give 2 litres over the next 8 h, then 1 litre every 8 h |
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consider colloid if systolic blood pressure <100 mmHg after 2 h |
|
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use hypotonic saline only very cautiously ( plasma Na+ >155 mmol/l, 1
litre over 8 h ) |
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monitor central venous pressure if cardiac disease |
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be more cautious in the elderly |
Insulin : |
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infuse initially at 6 U/h ( alternatively 20 U IM followed by 6-10 U each
hour ) |
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check pump and infusion lines and double dose if no response in 2 h |
Potassium : |
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|
give 20 mmol/h from the time of initiation of insulin infusion |
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discontinue temporarily if laboratory K+ >6.0 mmol/l |
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check every 2.0 h as a routine |
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if potassium falls to <4.0 mmol/l, increase accordingly |
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continuously monitor ECG |
Bicarbonate : |
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|
only use if pH is 6.9 or less |
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if indicated, give 100 mmol with 20 mmol K+ over 30 min |
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|
repeat blood gases and plasma K+ 30 min later |
Infection : |
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|
arrange urinalysis, chest X-ray, blood cultures |
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do not rely on temperature and leucocytosis |
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use antibiotics even if uncertain |
General care : |
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when glucose <13.0 mmol/l (<230 mg/dl ) : |
|
- start glucose-insulin-potassium regimen :
500 ml 10 % glucose ( dextrose ) + 24 U insulin + 20 mmol K+, at 80 ml/h
- aim for blood glucose 10.0-13.0 mmol/l ( 180-230 mg/dl )
by change of insulin dose
- start SC insulin therapy when able to eat
|
|
|
insert a nasogastric tube if the patient is comatose |
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|
insert a urinary catheter if no urine passed within 3 h |
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|
heparinize if coma, hyperosmolar, other risk factors |
Review cause to reduce risk of recurrence |
