Rehydration with IV fluid (Normal Saline) is the choice. Few boluses.
- Restore urine output
- Raise blood pressure
Use 0.45% NS for patients with hypertension, hypernatremia, or heart failure for hydration. Might use half normal saline for hydration because body has hard time managing all this sodium.
Switch to 0.45% NS after initial 2-3 hr hydration with NS
THEN When blood glucose level go down to 300 mg/dl, consider fluid change to D5W (glucose) to prevent precipitous decline of blood glucose while adminsitering insulin so there's no rebound hypoglycemic effect.
IV bolus of regular insulin based on sliding scale, then continuous infusion. We must monitor hourly. -.-
Gradual decent of blood glucose level to normal
Reverse the acidosis
Restoration of electrolyte balance: Cautious and timely potassium replacement & Insulin also enhances the movement of K+ from extracelluar fluid into the cells
As we give insulin and glucose, shift in potassium going from extracellular level to intracelular level, so they're given potassium replacement because we anticipate that shift.
-changes in electrolyts: changes in potassium and magnesium, we're anticipating cardiac dysrhythmias.
=> Monitor :
Blood glucose and renal function/urine output EKG and electrolyte levels: potassium, VS, lung assessments, signs of fluid overload. Changes in lung sounds.