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| NEWS |
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pitavastatin new for cholesterol
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FDA has approved pitavastatin in hypercholesterlemia
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Dietary fiber and diabetes
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Dietary fiber is linked to a reduced risk for type 2 diabetes
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Too Little Sleep May Raise Diabetes Risk
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Management of Diabetic Ketoacidosis
- Confirm diagnosis (↑ plasma glucose, positive serum ketones, metabolic acidosis).
- Admit to hospital; intensive-care setting may be necessary for frequent monitoring or if pH < 7.00 or unconscious.
- Assess: Serum electrolytes (K+, Na+, Mg2+, Cl-, bicarbonate, phos
phate)
Acid-base status—pH, HCO3-, PCO2, β-hydroxybutyrate
Renal function (creatinine, urine output)
- Replace fluids: 2–3 L of 0.9% saline over first 1–3 h (5–10 mL/kg per hour); subsequently, 0.45% saline at 150–300 mL/h; change to 5% glucose and 0.45% saline at 100–200 mL/h when plasma glucose reaches 250 mg/dL (14 mmol/L).
- Administer regular insulin: IV (0.1 units/kg) or IM (0.4 units/kg), then 0.1 units/kg per hour by continuous IV infusion; increase 2- to 10-fold if no response by 2–4 h. If initial serum potassium is < 3.3 mmol/L (3.3 meq/L), do not administer insulin until the potassium is corrected to > 3.3 mmol/L (3.3.meq/L).
- Assess patient: What precipitated the episode (noncompliance, infection, trauma, infarction, cocaine)? Initiate appropriate workup for precipitating event (cultures, CXR, ECG).
- Measure capillary glucose every 1–2 h; measure electrolytes (especially K+, bicarbonate, phosphate) and anion gap every 4 h for first 24 h.
- Monitor blood pressure, pulse, respirations, mental status, fluid intake and output every 1–4 h.
- Replace K+: 10 meq/h when plasma K+ < 5.5 meq/L, ECG normal, urine flow and normal creatinine documented; administer 40–80 meq/h when plasma K+ <3.5 meq/L or if bicarbonate is given.
- Continue above until patient is stable, glucose goal is 150–250 mg/dL, and acidosis is resolved. Insulin infusion may be decreased to 0.05–0.1 units/kg per hour.
- Administer intermediate or long-acting insulin as soon as patient is eating. Allow for overlap in insulin infusion and subcutaneous insulin injection
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