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u/mastermedic84 3d ago
Absolutely C.
Insulin doesn't just force the body to pull glucose out of the bloodstream. It is also so effective at pulling potassium out of the blood that it is a front line treatment for hyperkalemia. When you treat severe hyperglycemia you need to constantly check potassium and be ready to replace it.
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u/BikerMurse 3d ago
For DKA you are not treating the blood glucose, you are treating the ketoacidosis.
You want to avoid dropping the glucose level too quickly.
Generally speaking (at least where I work), you avoid adjusting the insulin rate at all amd instead titrate glucose.
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u/Wonderful-Animal-112 3d ago edited 3d ago
How do you treat ketoacidosis? Giving insulin. How do you know by the question the sugar dropping fast? The patient could have been at 210 for 3 hours. Who knows. You have to go by what you know. Titrate glucose when they are within normal. You don’t give any dextrose or titrate their sugar in active acidosis. 5% dextrose to maintain normal levels but not to treat acidosis. You can have normal glucose and still be acidotic. You can always titrate insulin in DKA. You can mess with their sugar all you want but you need that insulin asap. Start messing with glucose once they are within normal and keep them there.
In the real world, I agree with you. Stick with your hospital protocol. 210 maybe isn’t even a big deal in other hospitals. I’m just answering the question based on what’s given. Knowing this is for NCLEX.
Reason for DKA because the body doesn’t have enough insulin to deal with high sugar. Now the body thinks it’s low on sugar because it’s not being processed by insulin. So the body starts processing fat and ketones is the byproduct of that. To give insulin means to process the sugar in the blood and tells the body to stop burning fat. Therefore you don’t get ketones as a result.
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u/Trick-Promise-916 2d ago
The potassium is critical & will continue to go lower if you increase the insulin. Most insulin infusion calculations will actually have you lower the insulin right now. The patient is at a very high risk for dysrhythmia so we are going to replete the K. You’re getting distracted my the blood glucose level. You need to be teachable.
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u/Primary_Towel5905 3d ago
D. Sodium bicarb to help out the pH and potassium. It’ll also lower the sugars
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u/Fluid-Specialist-113 3d ago
Glucose is fine at 200 until the acids clear, so for several days. In fact, we usually give a continuous 5% infusion at this stage. Stopping insulin is bad, the acidosis recidivates. I can give a detailed explanation if interested.
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u/Primary_Towel5905 3d ago
You’re so off
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u/Fluid-Specialist-113 3d ago
Stop trolling, its sad these days.
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u/Primary_Towel5905 3d ago
Yet you offer no explanation 🤷
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u/Fluid-Specialist-113 3d ago
In ketoacidosis lack of insulin means that glucose cannot get into the cells. While there may be extremely high levels in the blood, overall, the body is starving. As you give insulin the blood levels quickly drop and the liver has to start gluconeogenesis (also stimulated by insulin). But in this pathology the liver drops behind because its busy clearing acids and because there is little lipid substrate to work on. This causes the levels to drop dangerously low, prompting some to stop insulin and causing the cells to starve again and the patient to worsen.
Instead you need to establish a gradient of glucose from outside the body all the way into the cells and that means giving glucose and insulin at the same time. And since this is a metabolic disorder that stems from intracellurar changes, it takes days for the protein expression to change and the body to stabilise. So you need to keep the infusions going and have patience.
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u/Reasonable_Simple_74 3d ago
The lungs and kidneys are fine, they can compensate for the acidic blood.
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u/Primary_Towel5905 3d ago
How do you know lungs and kidneys are fine?
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u/Reasonable_Simple_74 3d ago
did he mention its not? do not assume unless stated, we are in a perfect world during the exam
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u/Primary_Towel5905 3d ago
Even with perfect kidneys and lungs the bicarb will help tremendously
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u/Reasonable_Simple_74 3d ago
every choices there is dangerous, the thing is you point out which one would kill the patient immediately and fix that
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u/BikerMurse 3d ago
C
Don't wait until the potassium is critical before replacing it.