• Diabetic Ketoacidosis :
Confirm the diagnosis (Blood Glucose > 300 mg/dl ,PH <7.35 plus Ketosis ) .
Record the vital signs.
Insert an I.V cannula .
Draw blood for blood sugar, serum electrolytes ,blood urea and complete Haemogram ) .
Insert a Foley's catheter .
Measure Arterial blood gases .
Start I.V fluids Normal Saline , one liter per hour.
Start soluble Insulin give 20 units I.V followed by 5 to 10 units I.V hourly preferably as an infusion .
Measure blood sugar and serum k+ hourly .
Give k+ supplement when the level is normal (40 mmol per liter )
Change I.V fluids to Dextrose Saline when blood sugar approaches 250 mg/dl (14 mmol/l )
Continue I.V Insulin till ketosis disappear .
Bicarbonate is given when acidosis is sever ( PH < 7.0 ) and not corrected by the above measures .
• Hyperosmolar Non-ketotic Coma :
Complication of Diabetes type 2 .
Osmolaity is greater than or equal to 320 mOsm/l .
Treatment is similar to that of ketoacidosis .
Rehydration and treatment of hyperglycaemia is slower .
Do blood and CSF culture .
Give Intravenous Heparin .
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