Modified alberti regimen

Alberti regimen - alberti 와 thomas가 1979년 Management of Diabetes during surgery 에서 사용.

http://bja.oxfordjournals.org/content/51/7/693.full.pdf+html?ijkey=b2a01de41dd5bff4e59593e98ddd2354054fda30&keytype2=tf_ipsecsha 

Modified alberti regimen이라고 함은 이에서 변형된 regimen을 말한다. 

수술 당일 아침에 시작한다

 

BST q 2hrs, electrolyte q 4hrs

 

Fluid :  i) 10DW + KCL 30mEq mix IV - 100cc/hr

           ii) NS 500cc + RI 50 u mix IV  - 30cc/hr

 

If) BST < 100            ->   20cc/hr

   100 < BST < 200    ->  no changes

   200 < BST < 300    ->  RI 10cc/hr 증량 

   300 < BST             -> RI 20cc/hr 증량

 

   K < 4.0                 -> DW solution에 KCL 15cc 추가

  4 < K < 5               -> No change

  5 < K                     -> KCl 제외

 

Modified alberti regimen from Uinversity Hospitals of Leicester NHS

 

Commence 500 ml of 5% dextrose, with 1 gram (13 mmol, 1 mEq KCl = 1 mMol KCl) K⁺

in each bag, at 100 ml/hr via a volumetric pump, with insulin infusion by sliding scale as below.

(For patients with renal failure where restricted fluid input is necessary consideration

can be given to the use of smaller volumes of 10% dextrose instead)

 

• Commence IV insulin infusion (50 units of human actrapid in 50 ml of N/Saline)

 

Suggested insulin rate: (use green insulin chart)

 This may vary depending on the overall insulin required for the patient.

i.e. in type 2 patients on a larger dose and insulin higher rates may be required.

 

CBGT up to 4 mmol/l         (81mg/dl)            - 0.5 units per hour (inform doctor)

CBGT up to 4.1 – 7 mmol/l (83-140mg/dl)     - 1 unit per hour

CBGT up to 7.1 – 9 mmol/l (141-180mg/dl)   - 2 units per hour

CBGT up to 9.1 – 11 mmol/l(181-220mg/dl)   - 3 units per hour

CBGT up to 11.1 – 17 mmol(221-340mg/dl)   - 4 units per hour

CBGT up to >17 mmol/l(>340mg/dl)                           - 6 units per hour (inform doctor)

 

• Check capillary blood test CBGT post-op and then every 2 hours

• Check U&Es and lab blood sugar daily while on this regime

• Continue infusion until the patient is able to eat and drink

• Continue the infusion until the next meal,

  give S/C actrapid or short-acting analogue (about ⅓ of previous daily dose) 20 minutes before the meal

 • Stop IV insulin and dextrose 30 – 60 minutes after S/C injection

 • Check the insulin infusion if there is any doubt (e.g. has the IV tissued, etc)

 

(N.B. A regime in which 10 units soluble insulin and 10 mmol K⁺ are added to 500ml 10% dextrose

  which is then infused at 100ml/hr may be used {modified Alberti regimen}.

 It is IMPORTANT to note, however, that if the blood glucose is outside a range of 5-10 mmol/l

 or if the plasma K⁺ is outside the normal range the whole infusion needs to be changed

 for one with adjusted insulin or K⁺ content when using this regimen).