Should we give Iv Fluids in DKA with pulmonary edema in case of CAD WITH SEVERE LVD or in case of DKA with ARDS OR PNEUMONITIS where oxygen saturation is low..
Sir. Insulin infusion patient diabetes not controlled with 10 ml per hour , can we increase the dose hourly ? Reduction of RBS 50 TO 75 ML PER HOUR But it is not coming down to that range can we increase the hourly , how much to be increased hourly till it comes down to 50 to 75 ml per hour ?
Greetings Sir ! Sir some sources were saying we should use RL instead of NS because it will decrease the acidosis condition to certain level but NS will prolong acidemia..... Please clear the confusion sir...... 🙏
It's very important to find out the trigger.In most of the pediatric cases,infectious trigger is usually absent and antibiotics may not be necessary..Enquire the Insulin compliance..However,in a given patient it is very difficult to rule in or rule out infectious process as stress leucocytosis is present..Even If you don't start antibiotics at the first g.. .It's important to rule out sepsis in any case of DKA..
It is very difficult to assess fluid deficits in a DKA patient as the losses occur over a period of time and weight loss can be due to lipolysis and protein breakdown..and moreover despite the loss of Intracellular volume..owing to increase intravascular osmolarity..lot of fluid shifts occurs towards intravascular compartment making the fluid deficit assessment difficult.. If you have preillness weight that becomes the gold standard and easy to calculate fluid correction.
As we have hypokalemia in metabolic alkalosis,the opposite (hyperkalemia)is supposed to be there in metabolic acidosis sir.,but why there is hypokalemia here in dka sir?
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Yess
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Thank you. Very thorough explanation.
Very very detailed management! ❤
Must watch channel for every budding medicos...
One of the best lecture video ever seen 🙏🙏🙏 thank you sir
Thank u need such videos lectures in cardiac pulmonary..Git medicine..👏
Sir..one video management of DKA with hypoglycemia in type 1 DM
Thankyou so much for making such videos 🤍🙏
Should we give Iv Fluids in DKA with pulmonary edema in case of CAD WITH SEVERE LVD
or in case of DKA with ARDS OR PNEUMONITIS where oxygen saturation is low..
Very useful thank u sir
For overlap, if we are doing overlap at night time, then SQ dose 1/3rd should be given as intitial overlap dose or of morning dose 2/3rd at that time?
🧡
Sir. Insulin infusion patient diabetes not controlled with 10 ml per hour , can we increase the dose hourly ? Reduction of RBS 50 TO 75 ML PER HOUR But it is not coming down to that range can we increase the hourly , how much to be increased hourly till it comes down to 50 to 75 ml per hour ?
thank you, Sir
Well explained 👏
Very helpful for day to day practice. Thank you Dr.
Thank you sir❤❤❤
Greetings Sir !
Sir some sources were saying we should use RL instead of NS because it will decrease the acidosis condition to certain level but NS will prolong acidemia..... Please clear the confusion sir...... 🙏
Theoreticaly, but practicaly no
The initial IV Insulin dose of 0.15unit/kg (or 10U) is given as a stat dose or over a specific period of time?
Stat/infusion
Excellent
Sir plz reply if during treatment pottasium is 2.2 should we stop insulin?
Yes
Excellent sir
Thanks sir🙏
Thank you sir
Very nice
Sir whether antibiotics should be given
Depends on the precipitation factor
It's very important to find out the trigger.In most of the pediatric cases,infectious trigger is usually absent and antibiotics may not be necessary..Enquire the Insulin compliance..However,in a given patient it is very difficult to rule in or rule out infectious process as stress leucocytosis is present..Even If you don't start antibiotics at the first g.. .It's important to rule out sepsis in any case of DKA..
Do we calculate fluid deficit in DKA as we calculate in HHS or empirically start with NS 4 to 14 ml/hr
You can also get the help of other noninvasive methods ... hhs video to follow
It is very difficult to assess fluid deficits in a DKA patient as the losses occur over a period of time and weight loss can be due to lipolysis and protein breakdown..and moreover despite the loss of Intracellular volume..owing to increase intravascular osmolarity..lot of fluid shifts occurs towards intravascular compartment making the fluid deficit assessment difficult..
If you have preillness weight that becomes the gold standard and easy to calculate fluid correction.
Sir;why hypokalemia
instead of acidosis
Question not clear
As we have hypokalemia in metabolic alkalosis,the opposite (hyperkalemia)is supposed to be there in metabolic acidosis sir.,but why there is hypokalemia here in dka sir?
Thank u sir