Essential Facts on the Go: Internal Medicine (23 page)

The patient is typically very volume depleted

Start with isotonic IVF normal saline boluses until hemodynamically stable, then transition to a drip

Management of Ketosis

Insulin will shut off ketone production

It will also lower blood glucose, but stopping ketone production is its most important job

Check FS every hour

Check anion gap (AG) with chemistry every 3 hours

IV insulin

Bolus: 0.1 units/kg

Drip: 0.1 units/kg/hr

Do not turn off insulin drip until the anion gap is closed × 2!

Once FS < 250

– Change IVF to D5 1/2 NS

– This will allow the insulin GTT to continue until the AG is closed × 2!

Transitioning to subcutaneous insulin