Kerala State Drug Formulary.pdf

Endocrinology
‣ Tachycardia
‣ Hypotension / shock
‣ Hypothermia
‣ Altered level of consciousness – confusion, drowsiness , stupor,
coma
‣ Kussmaul’s breathing(deep sighing respiration) :- develops as a result
of metabolic acidosis
‣ Smell of acetone in breath may be present in some cases.
‣ Abdominal tenderness- mimicking acute pancreatitis or a surgical
abdomen
Classification of DKA:
Mild Moderate Severe
1 Plasma glucose (mg/dL) >250 >250 >250
2 pH 7.25-7.30 7.00-7.24 12
6 Alteration in sensorium Alert Alert/drowsy Stupor/coma
On diagnosis, all patients must be started on IV normal saline, the
first 500 mL should be given within 2 hrs and then 500 mL in 4 h, depending
on the state of hydration. The IV,fluid must be changed to glucose saline
once the random blood sugar (RBS) comes below 250 mg% or urine sugar
becomes less than 1%. All patients must be started on IV bolus of regular
insulin 0.15U/kg (10 -15U) followed by continous infusion at the rate of
0.1U/kg/h(5-7unit/h). Blood glucose should fall by 50-75mg/dL/hour.If serum
glucose does not fall by 50-75 mg/dL in first hour,double the dose of insulin
infusion hourly until glucose falls by 50-70mg/dL . Once the patient is
having urinary output,1 ampoule of potassium chloride 10 mL must be added
to every bottle of IV fluids. For proper management, frequent monitoring
of blood sugar, electrolytes, blood urea and arterial blood gases are
necessary and therefore the patient may be referred to a higher centre.
HYPOGLYCEMIA
This is a very common medical emergency which demands prompt
action. Suspect hypoglycemia in a diabetic on antidiabetic drug treatment
who missed a meal or was unable to take the food because of illness. Un
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