Resuscitate and seek help if required.
Give intravenous fluids a - initially 0.9% saline
(e.g. 1 litre over 30 min, 1 litre over 1 h, 1 litre over 2 h, 1 litre over 4 h).
If none of the following are present, fluids can safely be given more slowly if necessary
oliguria (<30ml/hr) during the first 4 hours of admission
renal insufficiency (urea > 21mmol/l or creatinine > 350
Give soluble insulin a
in low-doses (e.g. 5 to 10 units per hour) a intravenously d
at regular intervals or continuously.
c and capillary glucose frequently. d
Give potassium supplementation
after insulin therapy has begun if K+ < 5.5 mmol/l.
d Provide 10 to 30 mmol/h.
Give broad-spectrum antibiotics if there is evidence of infection. d
patients with hyperglycaemic hyperosmolar nonketosis, give heparin
5000 units sc every 12 hours. d
Continue giving insulin until a
glucose <10 mmol/l, and
ketones are cleared (3-hydroxybutyrate <0.5 mmol/l)
There is no clear benefit from
glucose < 10 mmol/l but ketones are still raised, continue the
insulin infusion with 5% or 10% glucose iv to maintain glucose 5 to 10
Once patients have stabilised and are eating, swap to subcutaneous insulin.
the first subcutaneous dose, then stop the infusion an hour later if
your patient remains well. d
routine phosphate supplementation