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DKAA
DKAA
Vol fluid resus (ml) 1L/1H 1L/2H 1L/2H 1L/4H 1L/4H This is the DKA fluid regimen
(NS) (NS) (NS) (NS) (NS)
Maintenance drip 6pt/NS 6pt/NS 6pt/NS 6pt/NS 6pt/NS If patient was given 6 pt NS , adjusted accordingly
regimen (pint)
NS Volume (ml/Hr) 1000 500 500 250 250 This case is 1L in 1 H for DKA regimen.
+125 +125 +125 +125 +125 But maintenance is also NS, so 3000/24
total : total : total : total : total :
1125 625 625 375 375
D5% / D10% Volume - - - - - Only if D5 and D 10 added
(ml/Hr)
Volume Output Hrly (ml) 500 700 900 950 110 Urine output , measure hourly (in case you forgot the total CBD, you can
500 200 200 50 0 put the total output on the right corner and then minus the previous
(700-500) (900-700) 150 total)- only write out the highlighted one, no need show calculation
Cumulative I/O (ml) 425 425 325 225 Important as we need to know the hydration status.
(+625) (+1050) (+1475) (+1800) (+2025) Right upper corner is i/o hourly ( so just add on previous accumulative
with current i/o)
Next Review 1am 2am 3am 4am 5am
1/ DIAGNOSIS (TAKE RBS, VBG, Serum ketone, Serum Osmolality, RP +/- septic workout if indicated)
ph<7.3, DXT>11.0, ketone>3
2/ Make sure there is CBD and 3 line (but In ED normally 2 branulla line: pls make sure there are function all the time: for insulin, for DKA regimen, for maintenance)
4/ K+ reading take from VBG run stat in ED or if got formal report then traced from formal report
5/ repeat VBG, RP post 1L/bolus , then update to check whether need another bolus. If not normally, RP, VBG, Ketone 4 hourly or as sp requested (in DKA), if in HHS add on
serum osmolality 4 hourly
6/ Anion Gap calculation ((Na + K) - (Cl +hco3)) : find from the VBG paper run stat in Ed or from RP formal report and VBG formal report which ever available
- Na: 140 K 4.3 Cl 101 hco3 13 therefore: 30.3
7/ Aim:
drop in sugar 3-5mmol hourly; not more than 5, afraid of cerebral oedema. If you noted more than 5 mmol, change the maintenance fluid used / half then insulin dose if
acidosis resolving
drop in ketone 0.5mmol/L/hour
increase in pH>3mmol/L/hour
9/ Insulin purpose is for persistent acidosis/ketosis, if acidosis not yet resolved, don’t half the dosage yet. Play around with the fluid first.
** if in ED, ketone machine at the VBG room in resus opp storeroom of resus** get the ketone strip from MA room. **