Hyperglycemia
Hyperglycemia
Cause of hyperglycemia identified on main ED workup.
No severe laboratory derangements
pH > 7.35
CO2 > 18
Anion Gap < 15
K+ > 3.0
Serum glucose > 350
No change in mental status
Diabetic ketoacidosis with anion gap > 15 or serum bicarbonate < 18
Severe infection or other condition as cause of hyperglycemia
Hyperglycemia requiring a continuous insulin infusion
Altered mental status
History of end stage renal disease or CHF precluding aggresive intravenous hydration
Unstable vital signs
Fingerstick Glucose Q2 hours x 6 hours, then every 4 hours
IV fluids
Subcutaneous insulin protocol
Diabetic diet
Check hemoglobin A1c
Diabetic education (FYI, This is not consistently available on weekends, if the patient really needs to see them before going home, then consider admit. Another option would be to have CM see patient and have a Home Health Nurse sent for DM education, which can happen on the weekend)
Disposition
Stable vital signs
Improvement in clinical condition
Reassuring diagnostic testing
Able to tolerate oral intake
Unstable vital signs
Worsening in clinical condition
Worsening diagnostic testing requiring further management
At the discretion of CDU providers or consultants