DKA Rx Question

[EctopicFetus]

So I took Step2.. and it was an interesting test to say the least..I had one Q which I am sure I got wrong but I wanted input from the people on here..

Long story short u have a person in DKA with glucose 450ish, +Ketones in urine.

The Q is medicine/fluid would you start. The options that WERE NOT there 0.9 NS, Insulin, or LR.

The options that were there 3% Saline and D5W. I was screwed trying to pick between those 2 even though I knew they were wrong. Anyone have any idea, as I am curious to know..

BTW I had one Q on that thing that had options A-Z and when i used the strikeout fxn it told me i reached my max of 20 items to strike out. I had numerous Qs that were A-M etc.. with stupid distractors.. Anyhow thanks for your time...

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[GeneralVeers]

D5W is correct. 3% saline would potentially kill the patient, as it would worsen the free water deficit. Generally you treat with 2 liters NS as a bolus on admission, and place the patient on an insulin drip (0.1 mg/kg). Once the glucose starts to drop you need to change them over to D5W, since you don't want to drop their glucose too low.

 

[cowgirlcarrie]

D5W is correct. 3% saline would potentially kill the patient, as it would worsen the free water deficit. Generally you treat with 2 liters NS as a bolus on admission, and place the patient on an insulin drip (0.1 mg/kg). Once the glucose starts to drop you need to change them over to D5W, since you don't want to drop their glucose too low.

That is still a pretty shady question. In reality you don't start D5W until the glucose gets to around 250. At 450 you would start NS. Bad question in my opinion. Are you sure the glucose wasn't 250?

 

[FoughtFyr]

Are you sure the glucose wasn't 250?

Come on now, be nice, don't make him/her second guess themselves over 1 question. To the OP: you achieved whatever score you achieved - the best part is IT'S OVER!

Go have a beer and play some video games...

- H

 

[EctopicFetus]

Come on now, be nice, don't make him/her second guess themselves over 1 question. To the OP: you achieved whatever score you achieved - the best part is IT'S OVER!

Go have a beer and play some video games...

- H

I truly am not one to ruminate.. I was more curious if there was something I missed in my training. I am 110% sure the glucose was ~450. I know the 250 rule. I just never heard of giving d5w until late in the game. I am not even worried about my score. I went out drank excessively and then went to sleep! It was cool! Glad thats over. Just step 2 CS which I am not looking forward to...

Thanks for the 411. SO I guess what I put was the best available answer.. Crappy question.. but thats ok..Onward and upward. I did 368 questions. I think it was more exhausting than Step 1.

 

[Idiopathic]

Looks like one of those 'least wrong' options to me.