Why is dextrose added to fluid given to patients with DKA and HHS?

Why is dextrose added to fluid given to patients with DKA and HHS?

A 5% or, rarely, a 10% solution of dextrose is added to the hydrating solution at this time to keep blood glucose at its respective level (by adjusting the insulin rate) until the patient has recovered from DKA (i.e., HCO3 >18 mEq/l, anion gap 12, and pH >7.3) or HHS (osmolality <315 mOsm/kg and patient is alert).

Why is D5W given with insulin?

Add 5% dextrose in water (D5W) when serum glucose levels reach 14 mmol/L in DKA so that insulin can be continued to achieve ketone clearance.

Why would a diabetic patient be given dextrose?

The dextrose is given to prevent the person from being hypoglycemic. The insulin is treating the elevated potassium. People with diabetes or hypoglycemia (chronically low blood sugar) may carry dextrose gel or tablets in case their blood sugar gets too low.

Why do you give dextrose before insulin?

IV insulin leads to a dose-dependent decline in serum potassium levels [16]. A combination of IV insulin dose of 10 units plus 25 g of dextrose reliably lowers the serum potassium level by 1 mEq/L (mmol/L) within 10–20 minutes and the effect lasts about 4-6 hours [17, 18].

Why is HHS worse than DKA?

Patients with HHS have been reported to have higher insulin concentration (demonstrated by basal and stimulated C-peptide levels),12 and reduced concentrations of FFA, cortisol, growth hormone, and glucagon compared to patients with DKA.

Which IV fluid is best for diabetic ketoacidosis?

Recent research suggests the fluid type used may be important in treating DKA. Normal saline (0.9% sodium chloride) is the most commonly used intravenous fluid in treating DKA, but it has a very high concentration of chloride and can lead to additional acid production when given in large volumes.

Which IV fluid is best for diabetic patients?

For decades, 0.9% saline has been the fluid of choice for diabetic ketoacidosis, and its use continues to be advocated in modern textbooks on diabetes. Early studies on diabetic ketoacidosis in the 1970s used 0.9% saline,5 and this approach was reinforced a decade later.

Why do you give d5 for DKA?

When the serum glucose reaches 200 mg/dL in a patient with diabetic ketoacidosis (DKA), IV dextrose is added to avoid the development of cerebral edema. In addition, the rate of insulin infusion may need to be slowed down to between 0.02 and 0.05 units/kg/hr.

What fluids do you give for hyperglycemia?

The 1st hour of fluids should be isotonic saline (0.9% NaCl) at the rate of 10–20 ml · kg–1 · h–1. In a severely dehydrated patient, this may need to be repeated, but the initial reexpansion should not exceed 50 ml/kg over the first 4 h of therapy.

What is the difference between glucose and dextrose?

Glucose and dextrose are basically the same thing. The names “Glucose” and “Dextrose” are often used interchangeably. Formally known as Dextrose Monohydrate or D-Glucose, dextrose is the most common type of glucose.

Can you run insulin with dextrose?

Standard insulin solution (1 unit/mL) may be prepared in sodium chloride 0.9% or dextrose 5% in water.

How much does 2 units of insulin lower glucose?

= 2 units of insulin will bring blood glucose of 190 mg/dl down to 120 mg/dl. Your new insulin plan: Insulin-to-carb ratio: You will need 1 unit of rapid-acting or short-acting insulin for each _____ grams of carb.

Why is IV dextrose given to patients with DKA?

Why is IV dextrose given to patients with DKA? When the serum glucose reaches 200 mg/dL in a patient with diabetic ketoacidosis (DKA), IV dextrose is added to avoid the development of cerebral edema.

When to stop IV fluids for diabetic ketoacidosis?

Stop IV fluids after 1st meal unless continued dehydration. a. If dehydration, remove dextrose from IV fluid, run NS at 1X maintenance General Guidelines for Meals Under 3 yrs of age – up to 30 gms3-5 yrs of age – up to 30-45 gms6-10 yrs of age – up to 60 gms11-14 yrs of age – up to 75gmsOlder than 15 yrs of age – up to 90 gms

How to treat adult diabetic ketoacidosis ( DKA )?

Management of adult diabetic ketoacidosis 1 Fluid therapy. 2 Insulin therapy. 3 Potassium, bicarbonate, and phosphate therapy. 4 Treatment of DKA in dialysis patients. 5 Metabolic treatment targets. 6 (more items)

How much fluid does a DKA patient need?

Patients were randomized to receive intravenous (IV) fluid at low volume (10 mL/kg bolus + 1.25 × maintenance rate) or high volume (20 mL/kg bolus + 1.5 × maintenance rate) (n = 25 in each).