tailieunhanh - Ebook Pocket guide to critical care pharmacotherapy (2nd edition): Part 2

(BQ) Part 2 book "Pocket guide to critical care pharmacotherapy" presents the following contents: Endocrinology, gastrointestinal, hematology, infectious diseases, neurology, nutrition, psychiatric disorders, pulmonary, renal. | Chapter 6 Endocrinology Table Management of diabetic ketoacidosis and hyperosmolar hyperglycemic state Identify precipitating factors Infection acute coronary syndrome cerebrovascular accidents trauma noncompliance with insulin pharmacotherapy new-onset diabetes mellitus and medications . corticosteroids and sympathomimetics Prepare a comprehensive flow sheet with vitals laboratory data fluid type and rates insulin rates and other treatments Correct fluid abnormalities Upon presentation normal saline infused at 15-20 mL kg h providing L in the first hour then 4-14 mL kg h for most patients Use clinical variables . blood pressure heart rate skin temperature to target euvolemia urine output may not be reliable in the hyperglycemic patient Monitor for hyperchloremic metabolic acidosis If serum sodium rises above 145-150 mEq L switch to hypotonic fluid replacement . saline . Lactated Ringer s solution may prolong ketoacid production by promoting alkalinization Serum sodium may rise with insulin and isotonic saline fluid administration estimate the corrected serum sodium concentration at presentation Add mEq L to the measured serum sodium for every 100 mg dL rise in blood glucose 200 mg dL When blood glucose falls to 200 mg dL switch to D5W D5W 1 2 NS or D5W NS depending on plasma sodium concentration continued J. Papadopoulos Pocket Guide to Critical Care 87 Pharmacotherapy DOI 978-1-4939-1853-9_6 Springer Science Business Media New York 2015 88 6 Endocrinology Table continued Regular insulin Do not initiate insulin therapy if the serum potassium mEq L. Maintain potassium levels between 4 and 5 mEq L during insulin infusion therapy Prepare 100 units of regular insulin in 100 mL normal saline new tubing should be primed with 20 mL of the infusion Use an ideal body weight to dose insulin in obese patients Bolus with units kg IV then units kg h continuous IV infusion Consider withholding the insulin bolus in the .

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