Management

• • • • • Fluids 1st: If hypotensive, NS @ 500-1000 ml/hr (Will lower Glucose by 35-70 mg/dl/hr)
        • When BP/UO responds ½ NS @ 250 ml/hr
        • Correct 50% free water deficit over 24 hrs
        • *Consider Swan-Ganz catheter placement in setting of pulmonary edema or renal failure
        • Insulin: If hypotensive, give 1-2 liters of fluid before giving IV (Insulin may exacerbate intrascular volume depletion by dirving glocose and water intracellularly)
        • Avoid IM or subcutaneous route (absorption unpredictable
        • IDENTIFY CAUSE: Infection, Ischemia, CVA, GI Bleed