Last Modified: 1:27pm 16/04/2021

12 to 24 hours


Ensure continuing improvement of clinical and biochemical parameters.
o Continue charting blood glucose hourly. Measurement of sodium and calculated osmolality can
be reduced to 4 hourly if improvement maintained (if not continue 2 hourly)
o Do not expect biochemistry to have normalised by 24 hr (sodium and osmolality are likely to be
o Take appropriate action (as outlined in time 60 minutes to 6 hours) as outlined above
depending on results.

Continue IV fluid replacement to achieve remaining replacement of estimated fluid losses within next 12 hours – this will be dependent on factors such as initial degree of dehydration / body weight etc and MOST IMPORTANTLY the response to treatment so far.

o Continue maintaining accurate fluid balance chart, plotting osmolality and make appropriate
adjustments to fluid replacement rates.

Continue IV insulin with or without 5 or 10% glucose solution to maintain blood glucose 10-15 mmol/L.
o Adjust insulin infusion rate hourly by 1 unit/hr increments or decrements to achieve desired BG.

Assess for complications of treatment e.g. fluid overload, cerebral oedema, extra pontine myelinolysis
(e.g. deteriorating conscious level).

Continue treatment of any underlying precipitant.

If patient not improving seek senior advice

JBDS Guidelines