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|