Case of the Month #47 A Sugar High

General Management Principles  

• 0.9% sodium chloride is principal 1^st line fluid of choice 
• Regular monitoring of osmolality to prevent rapid osmotic shifts (JBDS guidance recommends 1hrly osmolality measurements for the 1^st 6hrs, then 2hrly measurements if there is a satisfactory response (a fall of 3-8 mosmol/kg/hr)). 
• Serum sodium change should not exceed 10mmol/24hrs (aim for 3-8mmo) 
• Aim for glucose fall around 5mmol/L/hr 
• Encourage oral intake as soon as safe to do so