QuestionQA
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2844
Drug Calculations
Topic
9
Internal Medicine
10% dextrose = 10g in 100mL = 100g in 1000mL
Amount of glucose in 2 hours
= 2/8 x 100g/1000mL
= 25g
6912
10% dextrose = 10g in 100mL = 100g in 1000mL
 Amount of glucose in 2 hours
 = 2/8 x 100g/1000mL
 = 25g
QuestionQAAnswer
25
g
A 45-year-old man is admitted to Resus after collapsing and diagnosed with DKA. He is prescribed 3L of 0.9% Normal saline over 5 hours and a fixed rate insulin infusion of 7 units/hr. After the second bag, a repeat ABG is done, and due to a low BM, the saline is switched to 1L of 10% dextrose over 8 hours.  
  


Investigations:
  
| | |  |
| -------------- | :-------: | ------------------ |
| pH  | 7.30  | 7.35 - 7.45 |
| PaO₂  | 11 kPa  | 11 - 15 |
| PaCO₂ | 4.5 kPa | 4.6 - 6.4  |
| Bicarbonate | 18 mmol/L | 22 - 30 |
| Non-fasting Glucose  | 10 mmol/L | < 6.1  |
| Ketones (Serum)  | 2 mmol/L | < 0.6  |
 

BP 125/85 mmHg (120/80mmHg on admission)
  

Fluid Chart:
  

* 1300 0.9% Normal Saline 1L over 1 hour
* 1400 0.9% Normal Saline 1L over 2 hour
* 1600 0.9% Normal Saline 1L over 2 hour
* 1600 10% Dextrose 1L over 8 hours
  
 

How much (g) glucose would have been given to the patient 2 hours after the first 10% dextrose 1L over 8 hours was initiated?