Lytes

Question 1

Who are DKA and HHS usually seen in?

Answer 1

1. DKA: younger patients 2/ T1D

2. HHS: older patients w/ poorly controlled TIIDM

Question 2

Presentation DKA?

Answer 2

1. Absolute insulin deficiency
2. Hyperglycemia
3. Anion gap acidosis
4. Dehydration

Question 3

How to replace fluids in DKA/HHS?

Answer 3

1. Start w/ isotonic saline at 15-20 ml/kg per hou4
2. Switch to 1/2 isotonic saline when the Na normalizes
3. Add dextrose when glucose reaches 250 mg/dL

Question 4

How to add insulin in DKA/HHS?

Answer 4

1. Start with an infusion of regular insulin at 0.1 U/kg/hr

2. Double dose of insulin if glucose does not fall by 50-70 mg/dL in first hour

Question 5

How to handle K replacement in DKA/HHS?

Answer 5

1. If initial K under 3.3, DELAY insulin therapy until fluid and potassium replacement
2. Administer K w/ initial IVF if potassium levels are normal or low and maintained between 4 – 5

Question 6

Glucose and lytes monitoring in DKA/HHS?

Answer 6

1. Glucose every hour until stable, then every 2 – 4

2. BMP and blood pH every 2 – 4 until stablization

Question 7

Typical presentation HYPOglycemia?

Answer 7

1. AMS
2. Tachycardia
3. Diaphoresis

Question 8

Preferred method glucose admin in HYPOglycemia?

Answer 8

1. Oral: 300g/1200cal of carbs (soda, juice, sandwich, snacks), complex carbohydrates will be better at maintaining blood glucose levels
2. In adults start with 50 ml of 50% Dextrose in Water (D50). In pediatric patients use 1 ml/kg of 25% Dextrose in water or 2-4 ml/kg of 10% Dextrose in water

Question 9

What needs to be given to alcoholics with glucose?

Answer 9

Thiamine to prevent wernicke encephalopathy

Question 10

When to use glucagon in HYPOglycemia?

Answer 10

When theres no IV access. In adults administer 1 mg IM and 0.5 mg in pediatric patients < 20 kg . I

Question 11

When is octreotide useful in HYPOglycemia?

Answer 11

May be useful in the setting of sulfonylurea-induced hypoglycemia not responsive to other therapies

Question 12

Most common trigger thyroid storm?

Answer 12

Infection

Question 13

Triad thyroid storm?

Answer 13

1. Fever
2. AMS
3. Tachycardia