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Hyperglcyemia


please see the mild DKA protocol for more severe hyperglycemia



Inclusion Criteria

  • Blood sugar > 300 & < 600 after ED treatment
  • Normal to near normal pH and total CO2 level
  • Readily treatable cause (e.g. non-compliance, UTI, abscess)


Exclusion Criteria

  • New Onset or not previously diagnosed (exclusion as this likely requires additional education resources)
  • DKA (pH <7.20, total CO2 <18, elevated serum acetone, anion gap >18)
  • Hyperosmolar non-ketotic coma
  • Blood glucose > 600
  • Precipitating cause unknown or not readily treatable
  • Social issues – precluding adequate outpatient management

Potential Interventions

  • IV hydration, 0.9NS at 150-250 cc/hr
  • Bedside glucose q 2 hours until level < 300, then q 4 hours
  • Sliding scale insulin (see sliding scale guidelines)
  • Treat precipitating cause (antibiotics, I&D abscess, etc.)
  • Diabetic counseling
  • Repeat electrolytes q4hours until labs stable.

Discharge Criteria

Home

    • Blood glucose < 250
    • Resolution of symptoms
    • Stable vital signs
    • Successful treatment of precipitating cause
    • Tolerating PO fluids
    • PCP follow up within 48 hours if new onset
    • Patient education materials: includes BG monitor, lancets, strips, education video /book

Admit

    • Worsening symptoms
    • Unstable vital signs
    • Blood glucose remains > 250
    • Development of DKA
    • Unable to tolerate PO fluids
    • Poor candidate for home management


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