Patient Data
Phase 1: Resuscitation
The patient presents signs of dehydration and poor peripheral perfusion.
Usually 10-20 ml/kg to pass in 30-60 min.
Phase 2: Liquids
Calculate the fluids to replace (48h). Remember to use Holliday-Segar for maintenance and calculate the deficit according to severity (pH).
Mild 5%, Mod 7%, Sev 10%.
(Maintenance/24h) + (Deficit/48h).
Phase 3: Insulin
1 to 2 hours have passed since the start of fluid therapy. It is time to start the insulin infusion.
1. Select the recommended insulin dose:
2. How do you prepare the standard mix for the pump?
Phase 4: Dynamics
Hour 2
The patient has urinated (diuresis +). Control analysis: K+ 4.2 mEq/L.
Do you add potassium to serums?
Hour 4
Current capillary blood glucose: 230 mg/dL. Acidosis still persists (pH 7.25).
What do you do with the supplement serum?
Phase 5: Advanced Monitoring
Clinical Alert: Rapid Fall
Within hours of infusion, capillary blood glucose has dropped drastically (> 90 mg/dL per hour), but the patient remains frankly acidotic (pH 7.18 and positive ketones).
What is your behavior?
Clinical Alert: Stagnant Blood Glucose
After 2 hours of continuous insulin infusion, capillary blood glucose has practically not decreased (< 30 mg/dL total). Clinical hydration is adequate.
What is your most appropriate initial behavior?
Simulation Completed
Review of the patient's clinical management.