Correcting Acidosis
The next challenge is to correct the acidosis by addressing insulin deficiency. The loading dose of insulin is normally 0.1 to 0.2 U/kg IV. The insulin drip should then continue at (5-10 U/hr), to restore euglycemia and correct acidosis, while limiting rapid changes in serum osmolality. Follow blood glucose hourly for 4–8 hours. The goal is a decrease of 75–100 of serum glucose/hr.
It will be necessary to change IVF TO D5-1/2NS when plasma glucose reaches 250 (to avoid hypoglycemia and excessive decline in Sosm that could precipitate cerebral edema), with the goal of continuing the insulin infusion and resolving the acidosis. Decrease insulin drip to regular insulin 1u per hour for every 100cc/hr of D5-1/2NS in IVFs. | | | | | | | | |
