হাবিজাবি-২৬৯

Riday Sharker yes it is.

Rahima Nishi choice of fluid is NS as it does not contain dextrose. 250 drops/mins is actually very fast like running with a usually used cannula.

Kawsar Uddin type of fluid niye কোনো confusion ছিল না। drops/min নিয়ে confusion ছিল। confusion clear হয়েছে as running দিলেই হবে। 250drops/min দেখে মাথা ঘুরে গিয়েছিল। ধন্যবাদ clear করার জন্য।

Md. Rasel Mia একদিকে MI with ALVF, অন্যদিকে DKA. একটাতে fluid restriction করতে হয়, অন্যটাতে fluid infusion. MI with ALVF mortality is higher than DKA itself. তাই MI with ALVF এর management দিতে হবে, pulmonary oedema থাকলে diuretics দিতে হবে। যদি দেখা যায় রোগীর DKA related severe dehydration & hypovolumia with MI & ALVF সেক্ষেত্রে আগে insulin infusion দিয়ে DKA correction করতে হবে, তারপর যদি ALVF risk benefit ratio চিন্তা করে fluid under diuretic coverage দিতে হবে, rate of administration কমে যাবে। heart failure এর পর NT pro-BNP বাড়বে, বাড়বে urine output. fluid ongoing, increasing symptom of ALVF, decreasing hourly urine output - fluid আরো কমাতে হবে। patient condition & risk benefit অনুযায়ী clinical judgement করে plan of management ঠিক করতে হবে।

Kawsar Uddin Thank you so much, sir.

Faisal Alam 10%DA আর নরমাল স্যালাইন একসাথে চালালেই আর গ্লুকোজ বাড়বেনা।

Faisal Alam কয়েকটি জায়গায় এই sentence টা আছে DKA corrected, যদি এটা হয় stop insulin infusion & fluid. DKA corrected হলে রোগী orally fluid intake করতে পারবে - তাই fluid infusion লাগবে না, orally food intake করতে পারবে - insulin infusion লাগবে না - start subcutaneous insulin as per dose calculation according to body weight. DKA corrected হয়েছে কিনা কিভাবে বুঝবেন? রোগী clinically improved, biochemically improved - ketone body urine or blood বেশি ছিল কমে আসছে, HCO3 <15 ছিল - এখন >15, যদি ABG দেখেন এবং তখন pH <7.3 ছিল - এখন >7.3.

Taif Nour 1. hypovolumia induced hyperaldosteronism & hypokalemia. Catecholamines are not meant here. 2. 24 unit insulin in 100 ml NS is easy to administer @24 micro-drop/min for 4 hours for me. And if required then I can start again for the next 4 hours. 3. you said, 1000 ml/hr means 10 drops/min, it is wrong & probably your writing mistake. 1 ml = 15 drops (some say 20 drops) 1000 ml in 1 hour (60 min) 60 min - 1000 ml 1 min - 1000/60=16.67 ml/min 1 ml=15 drops 16.67 ml/min = 250 drops/min this is the actual math here which reveals a fraction number 4, and if we divide any fluid in ml by 4, it will give the number of drops/min to finish that ml in 1 hour.

Kawsar Uddin 1000ml/24 hr means 10d/min Yes its my typing mistake.

Kawsar Uddin actually your word was hyperadrenalism. Which is nothing but catecholamine. Thanks.

Riday Sharker please see the reply of the comment just above.

Kawsar Uddin if we use 50IU insuline in 50 ml N/S.. thn should we give it in 8 hrs? as per hr insulin requirement 6U.. thn should we give 6 microdrops/min? as [50 ÷(4×8)] = 1.5 drops..converting it to microdrops by multiplying with 4, [ 4×1.5 ] = 6 microdrops / min?

cz i saw giving insulin 50 IU in 50 ml N/S @6 microdrops/min

Riday Sharker instead of giving 6 micro-drops/min, 24 micro-drops/min is more convenient to me for administration. Besides, the 4 hours preparation of 24 unit insulin infusion is more logical to me to monitor 4 hour status & take subsequent decisions for the next shot.

Ahsan Khaled It's very simple. Insulin infusion is the treatment of choice in DKA irrespective of blood glucose level until DKA is corrected. For your kind information 14 is not the target glucose level, it is the level where hypertonic 10% DA is concomitantly administered to avoid cerebral oedema due to rapid decrease of osmolarity where initial osmolarity was high due to higher blood glucose level.

Abdulla Hill Kafi Alhamdulillah.