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INSULIN THERAPY,INTRAVENOUS ADMINISTRATION OF FLUIDS,CHECK FOR KETON EBODIES IN URINE ,KUSSMALS RESPIRATION,VITAL SIGNS MONITERING
Fluid correction with Normal saline
urin test for ketons
monitor for Kassmaul respiration
monitor for Hyperglycemia above 240mg dl
informed the doctor
fluids correction
managing potassium levels
managing hypo and hyperglycemia
MODIFIED MILWAUKEE REGIMEN.
CORRECTION OF HYDRATRION, MANAGEMENT OF DYSELECTROLYTEMIAS, MONITORING NEUROSENSORY FUNCTIONS.
CONITNUOUS INSULIN INFUSION/NS/MANAGE HYPERKALEMIA/HYDRATION CORRECTION/
SWITCH ON TO INTERMITTENT INFUSION OF INSULIN+DIETARY PRESCRIPTION
IV infusions of 0.9% or 0.45% of saline as ordered
moniotr electrolytes especially potassium level closely
monitor vital signs,urine output and mental status
assesment of general condition of the patient ABC, insert 2 wide bore canulaes and withdraw( RBS, ABG, KFT, CBCm CRPm HbA1c), start shock therapy by normal saline in the ER unitm check aceton in urine then transfere the patient to PICU. start Insulin infusion (full drip m half drip) according to RBS, ABG, Aceton in urin.
Calculate serum osmolarity to determine the total duration of infused insulin drip
monitor RBS/ Hr, acetone in urine/6 Hrs, ABG/ 12Hr.
after RBS normailzation start Insulin SC overlapping with infused insulin and start oral feeding to determine the corrected Insulin SC dose ( 3 doses short acting + one dose long lasting)
Correction of fluid deficits should be undertaken gradually over 12 to 24 hours in ICU is advisable.
Correction of hyperglycemia by regular insulin better to be by insulin pump.
Correction of electrolyte disturbance.Particularly potassium loss.
Correction of acid base imbalance if PH below 7.1.
Treatment of infection if present.
