QuestionSBA
QuestionChoice
Variable rate insulin infusion is only started when ketone levels falls below 0.6mmol/L
34467
c
Change to variable rate insulin infusion
QuestionChoice
This patient is on 0.1units/kg/hour of fixed rate insulin infusion, however, the response is inadequate (ketone reduction <0.5mM/h, glucose reduction < 3mM/h). Hence, decreasing the rate of insulin infusion will not be appropriate
34468
d
Decrease fixed rate insulin Actrapid infusion to 1.5units/hour
QuestionChoice
As K has dropped to 3.5-5.5mmol, 40mmol of KCl should be added to the bag of fluid as this patient would require continuous insulin infusion, which can result in the redistribution of potassium into the cells and the serum potassium level to decrease further
34466
b
Increase fixed rate insulin Actrapid infusion to 2.8 units/hour
QuestionChoice
Starting 1L of 10% dextrose over 8 hours is not necessary at this point as the blood glucose level is still above 14mmol/L but should be considered if the glucose level falls below 14mmol/L
34469
e
Start 1L 10% dextrose over 8hours
QuestionChoice
This patient is on 0.1units/kg/hour of fixed rate insulin infusion, however, the response is inadequate (ketone reduction <0.5mM/h, glucose reduction < 3mM/h). Hence, an increase in insulin rate by 1unit/hour increments hourly is necessary until the ketones are falling at target rates. As K has dropped to 3.5-5.5mmol, 40mmol of KCl should be added to the bag of fluid as this patient would require continuous insulin infusion, which can result in the redistribution of potassium into the cells and the serum potassium level to decrease further
34465
a
Increase fixed rate insulin Actrapid infusion to 2.8 units/hour and add 40mmol/L potassium chloride to 0.9% normal saline bag
QuestionComment
K should be given at 1mmol/kg/hr. So in 24hrs he shouldnt have more than 18mmol. Yet your flooding this child with 40mmol. Cant be right?
8500
QuestionComment
That's for maintenance fluids, not in the treatment of DKA. It's right. 
16831
User
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Neoplasia Dominant
QuestionComment
I thought the same thing too.
NICE guidelines for DKA in children: 'Include 40 mmol/litre (or 20 mmol/500 ml) potassium chloride in all fluids (except the initial intravenous boluses) given to children and young people with DKA, unless they have anuria or their potassium level is above the normal range. Do not delay potassium replacement, because hypokalaemia can occur once the insulin infusion starts.'
37179
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Abscess Jargon
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DNA Hypertension
QuestionComment
are the aims for ketone and glucose reduction available on BNF?

39488
QuestionComment
I can't find it so I'm assuming not? 
40498
User
subscriber
Amnesia Yeast
User
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Sunny
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
2836
Diabetic Ketoacidosis
Topic
77
Paeds
6904
Case Presentation:


A 5-year-old is admitted to the Emergency Department 3 hours ago and is being treated for Diabetic Ketoacidosis with 0.9% normal saline and fixed rate insulin Actrapid infusion 1.8units/hour IV.


 **On Examination**
RR 45/min (22-34).


Temperature 37.5 <sup>o</sup> C


HR 100/min (75-110)


O2 sats 96% RA.


Weight 18kg.


BP 110/80 mmHg.


 **Investigations**
 3 hours ago:


||||
|--------------|:-------:|------------------|
|pH|7.2|7.35 - 7.45|
|PaO₂|11 kPa|11 - 15|
|PaCO₂|4 kPa|4.6 - 6.4|
|Bicarbonate|12 mmol/L|22 - 30|
|Potassium|6 mmol/L|3.5 - 5.3|
|Non-fasting Glucose|18 mmol/L|< 6.1|
|Ketones (Serum)|3 mmol/L|< 0.6|


Now:

||||
|--------------|:-------:|------------------|
|pH|7.25|7.35 - 7.45|
|PaO₂|10 kPa|11 - 15|
|PaCO₂|4.5 kPa|4.6 - 6.4|
|Bicarbonate|15 mmol/L|22 - 30|
|Potassium|4 mmol/L|3.5 - 5.3|
|Non-fasting Glucose|16 mmol/L|< 6.1|
|Ketones (Serum)|2 mmol/L|< 0.6|




Question:
Select the most appropriate decision option with regard to his DKA management based on these data.
a