doubt...misshyd , samy anyone ? - funny3

[ArchivalUser]

clock has to be advanced until BMP comes back in a suspected DKA case with low side sugars around 300 to 500 before starting insulin drip. BMP takes 30 minutes if sugars are covered with sub q insulin in the beginning at 2 minutes of presentation ...thats enough!

Lower side sugars of 300 to 500 are not an emergency for you to use IV bolus!!

[ArchivalUser]

if patient is Diabetic fs of 200-300 you give fluid IV fluid alone will help and wait for BMP

[ArchivalUser]

yes larned, CORRECT!!!

[ArchivalUser]

anything above 400 you can treat with Iv bolus see harrison's ....please refer the global diabetes guidelines also.


Now if you r mentioning for patients presenting with 400 you can treat with IV insulin followed by infusion..even if you find acidosis your insulin dosage is not going to change.

Moreover it is not a rule that DKA presents with lower blood sugar ...it is mentioned it can ....many patients can present with sugar >400 with DKA.

so the protocol as stated by harrsion's & global diabetes guidelines is according to accucheck

if accucheck values 200-300 you wait for bmp with IV fluids only
if accucheck values 300- 400 you start s/c insulin wait for acidosis then start infusion if reqd
if accucheck >400 start Iv insulin 0.1 u /kg then start infusion @ 0.5 /kg/hr then wait for acidosis


this is the summary of guidelines as i read form these two sources.

Please verify the sources you might agree with me. Point is DKA doesnt always present with relatively low blood sugar can even present with sugar >400.

Thanks
Bumba

[ArchivalUser]

bumba
now this makes better, u seem to adjust it to 400....I think misshyd is right. We will never go wrong if we wait for BMP after giving insulin sub q in beginning. I think if anion gap give IV infusion. Lets keep that way than confusion

[ArchivalUser]

I m not adjusting anything ...this is what i reading & quoting ...nothing to compete or confuse just want to make my conception clear on starting infusion after bmp....

well if blood sugar is less we can wait ..if it high we cant wait .....this is the startegy ..anyway thanks

Bumba

[ArchivalUser]

Don't be mad, your help is really appreciate. you are great asset to this forum, sami, Missy, forever and others
Thanks

[ArchivalUser]

Very informative explanation , thanks all.

I need your advice, my patient is having trouble in ccs UW.
Patient was dxed with PE, started IV Heparin and add warfarin after 4 hrs as Pt, ptt was ok.

Then ptt started high more than 50, 60, and then 70,

I changed IV heparin to low molecular wt SC enoxaprin, but ptt was the same high.

So, I stopped heparin, then pt became more trouble with breathing and case ended up.so, I guess my patient got trouble.

My Q here is if coagulation failure after heparin n warfarin, ...I have to start IVC filter then stop heparin n warfarin?

Or just stop heparin, continue warfarin with IVC filter?

Appreciate u opinion!

[ArchivalUser]

which case number on USMLE world. ustable vital orstable vital. if stable you use heparin or lovenox before ptt and cbc stat and f/u ptt and cbc six hours later if low platelet you stop heparin and use aggrenox or leperidin. if high PTT you stop heparin and repeat ptt six hours later, if ptt low or normal I will recommend lovenox and warfarin if normal creatinine. IVC filter is for contraindication anticoagulation or anticoagulation failure. Tell me which case I will try to practice ANd get back to you

[ArchivalUser]

Great to hear, case no 38, from UW