I do have one question. So, bicarb is almost never indicated in DKA, however, when it is it needs to be isotonic bicarb. 3 amps in a liter of D5W. Do you try to reach a blood sugar level before you implement this? I think most providers would be hesitant in giving any sugar water to a patient in DKA who already has a BG over 1,000.
Maybe it's just a mistake. The recommended administration of sodium bicarbonate is 50 mmol in 200 ml of sterile water to be administered over 1 hour. This can be doubled and infused over 2 h until pH is > 7. 10 mmol of KCL can also be considered to be added to each 200 ml due to the expected hypokalaemia with sodium bicarbonate. Saludos desde Xalapa 🇲🇽
Remember that hyperglycemia isn’t the problem we’re directly trying to fix in DKA. The problem is the gap acidosis. That’s what’s going to kill them, not the sugar. The isotonic bicarb is a temporizing measure for a patient in extremis. They’re already getting IV insulin so the addition of ~100 mL per hour of D5 isn’t going to really make a difference in their lab work anyway.
Is there any negative effects on serum blood sugar in giving isotonic bicarb solution during the early phase of DKA management considering the solution is made with D5W? Can a litre of sterile water be an appropriate substitute to D5W? Thanks.
I do have one question. So, bicarb is almost never indicated in DKA, however, when it is it needs to be isotonic bicarb. 3 amps in a liter of D5W. Do you try to reach a blood sugar level before you implement this? I think most providers would be hesitant in giving any sugar water to a patient in DKA who already has a BG over 1,000.
Maybe it's just a mistake. The recommended administration of sodium bicarbonate is 50 mmol in 200 ml of sterile water to be administered over 1 hour. This can be doubled and infused over 2 h until pH is > 7. 10 mmol of KCL can also be considered to be added to each 200 ml due to the expected hypokalaemia with sodium bicarbonate.
Saludos desde Xalapa 🇲🇽
Remember that hyperglycemia isn’t the problem we’re directly trying to fix in DKA. The problem is the gap acidosis. That’s what’s going to kill them, not the sugar. The isotonic bicarb is a temporizing measure for a patient in extremis.
They’re already getting IV insulin so the addition of ~100 mL per hour of D5 isn’t going to really make a difference in their lab work anyway.
Is there any negative effects on serum blood sugar in giving isotonic bicarb solution during the early phase of DKA management considering the solution is made with D5W? Can a litre of sterile water be an appropriate substitute to D5W?
Thanks.
in the first hours did give insulin first or crystalloids serum in dka