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305meqkghriv monitorbloodsugarpotassiumarterialphand

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Unformatted text preview: deficit of 200­400 mEq, and NaCl deficit of 350­600 mEq Treatment of DKA Treatment of DKA Intubate for CNS depression Regular insulin 10 units IVP followed by 5­10 units/hr IV Normal saline 5­10 ml/kg/hr IV Add 5% glucose when serum blood sugar<250 mg/dl Potassium 0.3­0.5 mEq/kg/hr IV Monitor blood sugar, potassium, arterial pH and urine ketones hourly Identify cause (sepsis, MI, compliance) ANESTHETIC MANAGEMENT ANESTHETIC MANAGEMENT Goal­ blood sugar between 120­180 mg/dl Surgery scheduled early in the day ¼ to ½ usual daily dose of intermediate acting insulin on the morning of surgery Frequent blood sugar analysis, q 1­2 hours intraop Treat blood sugar values above 250 mg/dl Tracheal intubation in patients with autonomic nervous system neuropathy (pre­treat with metoclopramide) Choice of drugs for induction and maintenance less important than monitoring of serum blood sugar +/­ regional anesthesia due to peripheral neuropathies Risk of peripheral nerve injury with positioning Bradycardia and hypotension may require epi NIDDM NIDDM Obese, sedentary lifestyle, and advancing age Prevalence 6.6% Insulin resistance and a decrease in insulin secretion Usual onset after age 40 Insulin resistance is inherited Ketosis­resistant Insulin­mediated stimulation of tyrosine kinase is impaired. This is necessary for normal function of insulin receptors. Effect is reversible with improved control of serum blood sugar When dietary management fails hypoglcemic drugs stimulate endogenenous insulin secretion, or inhibit gluconeogenesis in the liver and kidneys, and increase glucose uptake in skeletal muscles Duration can be up to 36 hours HYPEROSMOLAR, HYPEROSMOLAR, HYPERGLYCEMIC NONKETOTIC COMA ­elderly, insulin deficiency, renal insufficiency, thirst deficiency ­sepsis, hyperalimentation or drugs (corticosteriods) ­glucose >600 mg/dl ­osmotic diuresis­>hypokalemia and dehydration ­serum osmolarity >350 mOsm/L ­pH >7.3 ­hypovolemia (severe, up to 25% total body water) ­patients are insulin deficient but liver insulin levels sufficient for metabolism of free fatty acids­>no ketosis...
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