An 11 year old type 1 diabetes mellitus patient was on CSII. While on holiday with her family she has become disoriented. On admission Na=126mEq/dl, potassium= 4.3mEq/dl, BUN= 100mg/dl, bicarbonate is 10mEq/dl and blood sugar is 600mg%. All are required for management except?
Correct Answer: 3% saline
Description: A patient of type 1 Diabetes mellitus is on Continuous subcutaneous insulin infusion. Due to device malfunction/tubing malfunction the delivery of insulin was halted. Since patients of type 1 diabetes are ketosis prone, she has gone into Diabetic ketoacidosis. The low bicarbonate points to acidosis. The patient's elevated blood sugar is drawing water into the intravascular compament and hence volume expansion explains the sodium deficit. However there is no need of hypeonic saline as correction of hyperglycemia by insulin shall suffice in managing sodium values. Hypeonic saline is only given in acute onset hyponatremia with neurological features. If severe hypophosphatemia can develop (<1mg/dl), phosphate should be replaced at no more than 3-4mmol/h infusion. Potassium replacement should be staed in 2nd to 3rd hour as acidosis begins to resolve.
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