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CPGs

Hyperglycemic

QuestionAnswer
When is this section in CPGs used -Patients with hyperglycemia and suspected diabetic ketoacidosis (DKA) or suspected hyperosmolar hyperglycemic non keto state (HHNS)
Treatment -measure ketones in patient's blood if possible -administer sodium chloride IV if the patient has signs of hypovolemia or poor perfusion
Sodium chloride 0.9% dose -1 litre for an adult over one hour -20ml/kg for a child over one hour -repeat as required
Backup ICP/CCP if severe shock
DKA additional info -Usually BGL greater than 20mmol/litre -Hypovolaemia from combination of osmotic diuresis, reduced oral intake and vomiting -Acidosis from metabolism of fatty acids and ketones. -non specific abdominal pain or vomiting
Patients on sodium-glucose cotransporter 2 (SGLT2) May present with euglycaemia DKA, where DKA occurs without the usual increase of blood glucose
Hyperosmolar hyperglycemic non-ketosis state -Occurs in type two diabetics because there is sufficient insulin present to present cells shifting to predominantly metabolising fat -hypovolaemia from osmotic diuresis
Diabetics that are unwell Low threshold to refer to doctor due to increased risk of developing infections, silent myocardial ischaemia and metabolic or electrolyte disorders
Cerebral oedema Rapid boluses of fluid may cause a rapid fall in glucose (by dilution) and this causes a rapid fall in osmolarity causing water to shift into the brain -children and adults at most risk due to no cerebral atrophy
Created by: nicolaprice01
 

 



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