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🌱來自: checklist

Hyperglycemic crises checklist

• ABCDE survey ___
• Establish IV access with two large-bore peripheral IV lines. ___
• Confirm diagnosis with:
  • blood gas ___
  • BMP ___
  • serum osmolality ___
  • serum ketones ___
  • urine ketones ___
• Identify and treat life-threatening causes ___
  • e.g., MI, sepsis
• Assess severity of DKA:
  • Moderate:
    • pH 7.0-7.24
    • SodBicar: 10-15 mEq/L
    • AG > 12 mEq/L
    • MS: Alert or drowsy, or ( severe: Stuporous )
• Begin fluid resuscitation with 0.9% NaCl.___
• Replete potassium and maintain K+ levels at 4-5 mEq/L.___
• Replete other electrolytes
• Start continuous insulin IV infusion
  • with hourly POC glucose checks once serum potassium is confirmed > 3.3 mEq/L.___
• Consider bicarbonate if pH < 6.9 despite adequate fluid therapy.___
• Adjust fluid resuscitation based on corrected sodium for hyperglycemia, serum glucose, and clinical response.
  • Corrected serum sodium ≥ 135 mmol/L: 0.45% NaCl
  • Corrected serum sodium < 135 mmol/L: 0.9% NaCl
  • Add dextrose once POC glucose is below 250-300 mg/dL.
• Identify and treat the underlying cause___
  • e.g., medication nonadherence, infection
• Order monitoring labs
  • e.g., BMP, serum osmolality, and blood gas every 2-4 hours___
• Consider endocrine consult.___
• Consider ICU admission.___