COVID-19 (DKA/HHS)

Experience is showing that those with diabetic patients with COVID-19 are more likely to develop DKA/HSS. However, treating them with the traditional large amount of fluid is detrimental to their chest, if they have Covid-19

Hence the following has been developed from the Guy & Thomas’ guidance – CLICK HERE

High Clinical Suspicion of Covid-19

  • Clinical: Fever ≥37.8°C plus any of; cough, short of breath, myalgia, headache, sore throat
  • CXR: consistent with Covid-19

DKA + Covid-19 (confirmed/high clinical suspicion)

  • Haemodynamically unstable (SBP < 100mmHg)- 500mls 0/9% NaCl 15mins (up to 2 bolus) early contact with ICU/CCOR team.
  • Fluid:

  • Insulin:
    • Infusion: 50unit Actrapid insulin to 49.5ml 0.9%NaCl (Run @ 0.1unit/kg/hr i.e 60kg adult – 6ml/hr)
    • Long-Acting: Levemir or Lantus, continue this at usual dose and times
  • Monitoring:
    • Fluid status – assessed hourly
    • Potassium – check every 2hrs (there are thoughts that Covid-19 may effect potassium)
  • Early Medical Input

HHS + Covid-19 (confirmed/high clinical suspicion)

  • Haemodynamically unstable (SBP < 100mmHg)- 500mls 0/9% NaCl 15mins (up to 2 bolus) early contact with ICU/CCOR team.
  • Fluid:

  • Insulin:
    • Infusion: Insulin infusion rates should start at 2 units/hr
      • Increase by 1unit/hr if: Blood Glucose OR Ketones – falls <0.5mmol/l/hr
  • Monitoring:
    • Fluid status – assessed hourly
    • Potassium – check every 2hrs (there are thoughts that Covid-19 may effect potassium)
  • Early Medical Input

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