IV fluids insulin potassium

IV reguler insulin

Determine hydration status estabilise adequate

Insulin: 0,1 U/kg renal function (urine cutput 50 ml/hr)

Severe mild cardiogenic body weigh as

Hipovolemia Dehydration shock IV bolus

Administer 0,9% hemodynamic K+ <3,3 mEq/L K+ >5,3 mEq/L

(NaCl 1,0 L/hr) monitoring/
Pressors 0,1 U/kg/hr IV
continuous Hold insulin and give Do not give K1
Evaluats connected insulin infusion 20-30 mEqK1/hr until but check serum
Serum Na= K7 >3,5 mEq/L K1 every 2 hrs

Serum Na= Serum Na= Serum Na=

If serum glucosa does not
Hight normal low
full by 50-70 mg/dl in first K+ = <3,3 mmEq/L
0,45% NaCl 0,45% NaCl hour, double onsulin dose
(250-500 ml/hr) (250-500 ml/hr)
depanding on deppanding on Give 20 – 30 mEq K1 in each liter
Hydration state Hydration state When serum glucosa reaches 300 of IV fluid to keep serum K+
mg/dl, reduce reguler insulin infusion between 4-5 mEq/L
to 0,05-0,1 U/kg/hr IV. Keep serum
When serum glucosa
glucose between 250 and 300 mg/dl
reaches 200-250
mg/dl change to 5% until plasma osmolarity is <315
dextrose with 0,45% mOsm/kg and patient is mentally alert
NaCl at 150-250 ml/hr

Check electrolytas,BUN, creatinine and glucose every 2-4 hrs until stable. After resolution
of HHS and when patient is able to eat, inittiate SC multidose insulin regimen. Continue IV
insulin infusion for 1 – 2 hr after SC insulin begin to ensure adequate plasma insulin levels.
In insulin paive patients, start at 0,5 – 0,8 U/kg per day and adjust insulin as needed. Look
for precepitating cause(s).