Treatment
(1)Transfusion:3~4 L fluids in the first 6 hours(NS),3 L in the next 18 hours start with NS.alternate with RL(be careful in elderly/heart failure patients).
(2)Insulin:give 15~20 U Soluble Insulin by intravenous drip,insulin sliding scale(not ideal).
(3)Insulin pump:5 U/h,e.g.100 U Soluble insulin in 50 mL(=2 U/mL).
RBS>500 mg/d L→2.5 mL/h(=5 U/h).
RBS>400~499 mg/d L→2.0 mL/h(=4 U/h).
RBS>300~399 mg/d L→1.5 mL/h(=3 U/h).
RBS>200~299 mg/d L→0.5 mL/h(=1 U/h).
RBS>150~199 mg/d L→0.2 mL/h+D5%-drip.
RBS><150 mg/d L stop perfusion,switch to insulin acc.to rule thirds.(Be aware of signs of hypoglycemia.)
(4)Na-bicarbonte only in severe cases(can cause hypokalemia).
(5)Potassium according to the laboratory examination.
(6)Control infection,particularly using antibiotics in elderly TypeⅡ-patients(UTI).(https://www.daowen.com)
(7)If RBS<250 mg/d L and Ketones in DKA<++,try to use oral antidiabetic in HONK patients and put on lente/soluble(acc.to rule of thirds)in DKA.
Abbreviations
DKA(diabetic ketoacidosis):酮症酸中毒
HONK(hyperosmolar non-ketotic diabetic coma):高渗性非酮症糖尿病昏迷
FBC(full blood count):血常规检查
RL:林格氏
RBS:血糖值
ACC.TO:根据
UTI(urinary tract infection):尿道感
NS:生理盐水
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