Question: This question was addressed at the end of January but I'm still unclear on the answer. In our protocol is discusses DKA and the patch point for pts from 2 to 12 for obvious reasons to me. It does not discuss any patient greater than 12. In the past if pt was DKA and showing signs of dehydration we could do a 10ml/kg bolus, then it was changed so that we had to patch for this bolus. The previous question was weather or not we were doing boluses for adults and it was not addressed. There is no talk of it in our latest protocols. Can we go ahead and bolus an adult in DKA who is showing signs of dehydration without a patch or even with a patch?
Thanks for the question; sorry we did not answer your specific query the first time.
The confusion surrounds the "old" vs the "new" directives and patients with DKA. In both the "old" directives AND the "new" directives, in order to be able to administer a fluid bolus under the Intravenous and Fluid Therapy Medical Directive, the patient has to be hypotensive. In the "old" Suspected Hypoglycemia Protocol, note 3 stated that "If glucometry indicates the patient's reading is >25mmol/l, consider that these patients may be significantly dehydrated. Consider establishing IV access and contacting BHP for fluid administration orders if certified."
No such mention exists on the "new" Hypoglycemia Medical Directive.
So, in essence, in order to qualify for IV fluid without a patch (adult DKA or not), a patient must be hypotensive. If the patient is < 12yo and has suspected to be in DKA, a patch is required.
If an adult patient is NOT hypotensive but due to suspected DKA (or another form of dehydration) a paramedic wishes to administer a fluid bolus, a patch would be required.