In severe DKA, always start regular insulin infusion at the rate of 0.1 IU/kg/hour AFTER bolus fluid 20 ml/kg NS or RL over one hour . When child is improving ( signs of acidosis are decreased) usually after 6-12 hours, then taper regular insulin infusion from 0.1 to 0.05 IU/kg/hour. In less than 4 years age children with mild to moderate DKA, we can start regular insulin infusion 0.05 IU/kg/hour after bolus fluid. 🙏🙏
Maam, you explained so nicely...but in routine practice clculations make the procedure more scary to try.. i mean we have to practice lot in order to get used to the calculations
There is an unavoidable iatrogenically induced rise in serum chloride with the use of normal saline in the initial resuscitation of children presenting in DKA and shock. The incidence of hyperchloremia is significantly less with the use of half normal saline. Half normal saline is not associated with a decline in the corrected serum sodium concentration and does not affect the rate of correction of acidosis or rate of drop in blood glucose or duration of DKA resolution when compared to normal saline solution as post-bolus rehydration fluid therapy in pediatric patients with DKA. Read this article for details- www.researchgate.net/publication/350566485_Outcome_of_the_use_of_09_saline_versus_045_saline_for_fluid_rehydration_in_moderate_and_severe_diabetic_ketoacidosis_in_children
Superb mam. Thanks teachers like you are there who wants to share the knowledge unlike shit professors sitting in medical Colleges who are good for nothing.
Very nice presentation mam! Mam how much keones in urine considered to b fullfilling the criteria if we dont have access to blood ketones level?. 2+ or 3+
Very very thanks mam every teaching class of u helping very much mam pls make video on management of electrolyte imbalance and acid base disorders thanku mam
Times used to be very Challenging, I had the worst days of my life living with diabetes, I appreciate you so much Dr Igudia, You have restored me my life that was lost already . Thank you so much for curing me of my diabetes with your natural Herbs
Ma'am how have you calculated regular insulin infusion rate i.e. 2.08ml/hour? Plus do we always dilute the regular insulin in 50 ml NS? Please clear my queries ma'am, I'll be highly obliged :)
Hello Fatima, 50 ml ➗ 24 hours =2.08 ml/hour. No, it's not necessary to dilute in 50 ml fluid. But it's easy to use 50 ml syringe in syringe pump, so we generally do this.
Thank you for never letting me down doc. being recommended to doctor Igudia on RUclips has being a great blessing to my family his cure for diabetes is a genuine one thanks for your good deed toward humanity
You have my maximum respect Dr Igudia, I am now negative from my diabetes after I did the test, I wonder what might have become of me it I didn't get the herbal cure From your RUclips channel. God bless you sir
In severe DKA, always start regular insulin infusion at the rate of 0.1 IU/kg/hour AFTER bolus fluid 20 ml/kg NS or RL over one hour . When child is improving ( signs of acidosis are decreased) usually after 6-12 hours, then taper regular insulin infusion from 0.1 to 0.05 IU/kg/hour.
In less than 4 years age children with mild to moderate DKA, we can start regular insulin infusion 0.05 IU/kg/hour after bolus fluid.
🙏🙏
tell us how you drive to 2.08mls per hr when dilluting it
Honestly speaking .this lecture helped a lot..Thanks
Honestly speaking .this lecture helped a lot..Thanks
Brilliant lecture mam you are superb...you made my life very easy to understand DKA..
Glad to hear that
Excellent Madam please keep uploading more videos
Thank you, I will
Maam, you explained so nicely...but in routine practice clculations make the procedure more scary to try.. i mean we have to practice lot in order to get used to the calculations
Just by practice, it's easy to calculate
Very useful ...
Plz upload more videos
Definitely
Thank u so much maam🙏I am in first year,totally out of clue how to manage,ur video helped me lot maam,
Welcome
Same here... Indebted to u mam for a lifetime 🙏
Great and very informative video.. Thank you
Welcome
Useful and Informative.... Thank you maam... Please Upload more such useful videos.... Thank you maam...
Definitely
thank you very much doctors, i needed the quick review so much, thanks
You are welcome!
Mam you are really a great teacher please continue with the lectures
Thank you, I will
Very nice informative lecture... Thank you so much mam.... 🙏
Most welcome
Ma'am there is chance of cerebral edema in DKA. so why we are using 1/2 NS ( hypotonic ) instead of NS ?
There is an unavoidable iatrogenically induced rise in
serum chloride with the use of normal saline in the initial resuscitation of children presenting in DKA and
shock. The incidence of hyperchloremia is significantly
less with the use of half normal saline. Half normal saline is not associated with a decline in the corrected
serum sodium concentration and does not affect the rate
of correction of acidosis or rate of drop in blood glucose
or duration of DKA resolution when compared to normal saline solution as post-bolus rehydration fluid therapy in pediatric patients with DKA.
Read this article for details-
www.researchgate.net/publication/350566485_Outcome_of_the_use_of_09_saline_versus_045_saline_for_fluid_rehydration_in_moderate_and_severe_diabetic_ketoacidosis_in_children
Superb mam. Thanks teachers like you are there who wants to share the knowledge unlike shit professors sitting in medical Colleges who are good for nothing.
Excellent presentation
Thank you so much mam🙏🙏
Most welcome
So helpful mam👌😊
Welcome
Thanks mam very good video... please continue the good work 👍
Welcome 🙏
Its very nice video..
Mam
Plz upload management after DKA , how to monitor in opd clinic in regular basis...
Sure
Madam please let me know why you have added 850 to 1000 in maintenance fluid calculation
According to milwaukee formula for dka
very useful and appreciate your work
Thank you
Very nice presentation mam! Mam how much keones in urine considered to b fullfilling the criteria if we dont have access to blood ketones level?. 2+ or 3+
Ketones measured in the urine does not equate to the plasma ketone concentration so even 1 + or 2+ urine ketones should be considered significant.
Thanks🙏🙇 for video..
Welcome
So nice madam, please post of video on antenatal and post nata management of paediatric hydronephrosis
🙏
Thank you mam
Most welcome
Thank you so much mam
🙏🙏🙏🙏🙏
Welcome
Very informative.. Thank you mam👍
Welcome
Thank you so much mam for accilant explanation
Welcome
Very very thanks mam every teaching class of u helping very much mam pls make video on management of electrolyte imbalance and acid base disorders thanku mam
Welcome and definitely I will take lectures on these topics
Mam why bicarbonate not prefered if ph>6.9 , any articles for that??
www.ncbi.nlm.nih.gov/pmc/articles/PMC6242725/
Read article & mentioned in conclusion
@@learningpediatrics5347 thanks mam
Thank u mam for this informative lecture
Welcome
Amazing teacher 🙏
🙏
How do we get 850mls that was added to the maintenance fluid thanks
This is the formula to calculate fluid for DKA (Milwaukee)
Awesome lecture mam thank u alot
Welcome
I don't understand where the 85mls/kg is coming from can you please explain. Thank you
Dear Toa,
It's Milwaukee formula
Very useful and interesting
Thanks
Thank you
Welcome
Well expined
Thanks mam very good video
Most welcome
Thanks mam please video on GIR 6 and more..
Treatment of GIR refractory hypoglycemia...
Definitely
Thank uh so much ma'am ....🤗👍
Welcome
Thank u ma'am..
Welcome
Thank you so much ma'am
Welcome
Ma injection dopamine ki calculation pe video banaye
Go through it
Details is given in it
ruclips.net/p/PLc_6a4-RjRzckzzWnvqmwOgva11sY63l5&feature=shared
Informative
Thank you
Thanku mam.Plz put more n more peads lectures
Welcome
sure
Nice work didi
Thank you
Times used to be very Challenging, I had the worst days of my life living with diabetes, I appreciate you so much Dr Igudia, You have restored me my life that was lost already . Thank you so much for curing me of my diabetes with your natural Herbs
Thanks Ma'am ❤
Most welcome
Thank you ma'am
Welcome
Mam how to prepare 0.45% DNS.??
It's available
Or
By mixing equal amount of 10% Dextrose and 0.9% NS fluid.
Learning Pediatrics thanx v much MAM
Thank you mam..really well explained
Welcome
THANK U ALOT ❤
🙏
Plz mam make video on insulin regimen basal bolus regimen mix split regimen modified mix spit regimen and diabetic food chart
Definitely
Great
Thank you
maam could you make a video on congenital hypothyroidism ?
Definitely Surya
@@learningpediatrics5347 thankyou so much ma'am
Thank you madam😀
Welcome
Chances of death .9 per cent?? For cerebral oedema??
Cerebral edema is the leading cause of death in dka
It's chances are 0.9% in dka
Once it develop, chances of death is 20-30%
Thanks mam....
Welcome
Mam ..Milwaukee formula ( 85ml/kg +maintenance fluid) -initial bolus given for 1hour /23
It's also correct mam ?given in Nelson...
Dear Ramesh,
Both are correct.
@@learningpediatrics5347 tq mam
Ma'am how have you calculated regular insulin infusion rate i.e. 2.08ml/hour?
Plus do we always dilute the regular insulin in 50 ml NS? Please clear my queries ma'am, I'll be highly obliged :)
Hello Fatima,
50 ml ➗ 24 hours =2.08 ml/hour.
No, it's not necessary to dilute in 50 ml fluid. But it's easy to use 50 ml syringe in syringe pump, so we generally do this.
@@learningpediatrics5347 okay ma'am, thanks a lot🌼
Thank you for never letting me down doc.
being recommended to doctor Igudia on RUclips has being a great blessing to my family his cure for diabetes is a genuine one thanks for your good deed toward humanity
You have my maximum respect Dr Igudia, I am now negative from my diabetes after I did the test, I wonder what might have become of me it I didn't get the herbal cure From your RUclips channel. God bless you sir
Aapko pranaam.
🙏