I.

INTRODUCTION

Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic

diseases in which a person has high blood sugar, either because the body does not
produce enough insulin, or because cells do not respond to the insulin that is produced.
Insulin, a hormone released from the pancreas, controls the amount of sugar in the
blood. When people eat or drink, food is broken down into materials, including the
simple sugar glucose that the body needs to function.
Sugar is absorbed into the bloodstream and stimulates the pancreas to produce
insulin. Insulin allows sugar to move from the blood into the cells. Once inside the cells,
it is converted to energy, which is either used immediately or stored as fat or glycogen
until it is needed. This high blood sugar produces the classical symptoms
of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased
hunger).

Types of Diabetes Mellitus

Type 1 Diabetes
Type 1 Diabetes (previously known as insulin-dependent diabetes) is an auto-
immune disease where the body's immune system destroys the insulin-producing beta
cells in the pancreas. This type of diabetes also known as juvenile-onset diabetes.
People with type 1 diabetes must inject themselves with insulin several times a day and
follow a careful diet and exercise plan.

Type 2 Diabetes
Type 2 Diabetes (previously known as non-insulin dependent diabetes) is the most
common form of diabetes. This type of diabetes, also known as late-onset diabetes, is
characterized by insulin resistance and relative insulin deficiency. The disease is
strongly genetic in origin but lifestyle factors such as excess weight; inactivity, high
blood pressure and poor diet are major risk factors for its development. Symptoms may
not show for many years and, by the time they appear, significant problems may have
developed. People with type 2 diabetes are twice as likely to suffer cardiovascular
disease. Type 2 diabetes may be treated by dietary changes, exercise and/or tablets
insulin injections may later be required.
Sign and Symptoms of Diabetes Mellitus

Flu-like symptoms. Diabetes can sometimes feel like a viral illness, with fatigue,
weakness and loss of appetite. Sugar is your body's main fuel, and when it doesn't
reach your cells you may feel tired and weak. Weight gain or loss. Because your body
is trying to compensate for lost fluids and sugar, you may eat more than usual and gain
weight. Slow-healing sores or frequent infections. Diabetes affects your body's
ability to heal and fight infection. Bladder and vaginal infections can be a particular
problem for women. Nerve damage (neuropathy). Excess sugar in your blood can
damage the small blood vessels to your nerves, leading to a number of symptoms. The
most common are tingling and loss of sensation in your hands and especially your feet.
Blurred vision. High levels of blood sugar pull fluid out of the tissues in your body
including the lenses of your eyes. This affects your ability to focus.

Incidence of Diabetes Mellitus

Diabetes is one of the most common chronic diseases in children and adolescents;
about 151,000 people below the age of 20 years have diabetes. Health care providers
are finding more and more children with type 2 diabetes, a disease usually diagnosed in
adults aged 40 years or older. Diabetes affects 25.8 million people of all ages 8.3
percent of the U.S. population. In 2006-2009, based on fasting glucose or hemoglobin
A1C (A1C) levels, 35 percent of U.S. adults ages 20 years or older had prediabetes—
50 percent of adults ages 65 years or older. Applying this percentage to the entire U.S.
population in 2010 yields an estimated 79 million American adults ages 20 years or
older with prediabetes. Diabetes is the leading cause of kidney failure, nontraumatic
lower-limb amputations, and new cases of blindness among adults in the United States.
II. PATIENT’S PROFILE

Name: Z.V.O.
Date of Birth: May 15, 1946
Place of Birth: Mandaluyong city
Age: 65 y/o
Sex: Female
Nationality: Filipino
Attending Physician: Dr. M
Psychosocial Stage: Generativity vs Stagnation (According to Erik Erickson)

Chief Complaint: Gangrenous Left Big Toe

Final Diagnosis: Left big toe amputation, DM 2 Uncontrolled, HPN 2 Uncontrolled

History of Present Illness:

3 month PTC, patient big toe nail on left foot was removed spontaneously No
trauma, no fever, no chills, they consulted a private clinic and was prescribed with
bactroban, which she used compliantly however there was no improvement on the
wound.
2 month PTC, she stopped using bactroban instead applied betadine still no
improvement.
1 month PTC, persistence of symptom she took unasyn BID and pursue the
usage of betadine. There were no a companying symptom. No consultation was done.
Few days PTC, the wound/ lesion of left big toe increased in severity and she noted
pain / tenderness she compliantly took unasyn which she afforded slight relief of the
tenderness. Few hours prior to consult due to persistence of symptom hence consult at
the E.R.

Family history:

The patient has (+) hypertension (uncontrolled) and diabetes mellitus

(uncontrolled) in their family, (-) for asthma and any pulmonary diseases. She has no
any allergies to medications and food.

Past medical history:

The patient didn’t have any illnesses for the past 6 months. She was only
complaining about her pain on her left toe.
III. PHYSICAL ASSESSMENT

Normal Actual
Body Parts Technique Analysis
Findings Findings
Skin Inspection -light to dark -brown
Palpation brown
-no swelling -no swelling
-good skin - poor skin - poor skin
turgor turgor turgor is due to
aging and
diabetes
mellitus 2
Hair and scalp Inspection -no lesion -no lesion

-color black -color black

Head Inspection -face is -face is
symmetrical symmetrical

Neck Inspection -no lesion -no lesion

-no swelling -no swelling
Eyes Inspection -symmetrically -symmetrically
align align

-blinking -blinking
Eye brows symmetrically symmetrically

Eye lashes -Evenly -Evenly

distributed distributed
Eye lids
-eyelashes are -eyelashes are
Sclera short short
-eye lid margins -eye lid margins
Pupil are moist are moist
-white in color -white in color

-equally round -equally round

and reactivated and reactivated
to light to light
accomodation accomodation
Ears Palpation -equal in size -equal in size
Inspection -symmetrically -symmetrically
align align
-no lesion -no lesion
-no swelling -no swelling
Nose Inspection -color is same -color is same
as face as face
-no lesion -no lesion
-no swelling -no swelling
Mouth Inpspection -no lesion -no lesion
Palpation -no swelling -no swelling

Lips -red to pink in -pink in color

color
-no lesion -no lesion
Buccal mucosa -smooth with no -smooth with no
lesion lesion
Tongue -red to pink in -red to pink in
color color
-no lesion -no lesion
-no swelling -no swelling
Gums -pink and moist -pink and moist

Teeth -symmetrically -symmetrically

align align
Breast Inspection -symmetrically -symmetrically
Palpation align align
-smooth -smooth
-no mass -no mass
-no lesion -no lesion
-no swelling -no swelling
Upper Extremities Inspection -symmetrically -symmetrically
Palpation align align
-no lesion -no lesion
-no swelling -no swelling
-no mumps -no mumps
-light to dark -light to dark
brown in color brown in color
Abomen Inspection -smooth to -smooth to
Palpation touch touch
-no lesion -no lesion
-no swelling -no swelling
-no mumps -no mumps
-no redness -no redness
-warm to touch -warm to touch
-round and -round and
symmetrical symmetrical
-abdomen rises -abdomen rises
with inspiration with inspiration
in synchromy in synchromy
with chest with chest
Lower Extremities Inspection -bilaterally -bilaterally
symmetrical and symmetrical and
equal equal
-right foot has -right foot has
complete fingers complete fingers

-left foot has -left foot has no -left big toe was
complete fingers big toe amputated due
to gangrenous
left big toe
(1/8/12)
-skin color is as -skin color is as
same as the same as the
other parts of other parts of
the body the body
Vital Signs

January 4, 2012
Time Blood Pressure Pulse Rate Respiratory Rate Temperature
8 am 130/80 64 18 36.8
12 nn 130/80 74 20 37.8
4 pm 130/80 80 20 38.3
8 pm 130/70 90 21 38.2
9 pm 37.5
12 mn 140/90 84 20 37.4
4 am 140/90 86 24 37.8

January 5, 2012
Time Blood Pressure Pulse Rate Respiratory Rate Temperature
8am 130/80 72 20 36.5
12nn 150/90 82 18 37.4
4pm 160/90 80 19 38.0
8pm 150/90 74 24 37.2
12mn 130/90 79 24 37
4am 140/90 79 24 37

January 6, 2012
Time Blood Pressure Pulse Rate Respiratory Rate Temperature
8am 120/90 80 20 37
11:40 160/100 80 24
12:20 150/100 81 20 37
12:45 150/90 81 25 36.7
1pm 150/80 84 20
2pm 140/90 86 20 36.8
4pm 140/90 78 19 37.5
8pm 130/80 80 21 37.1
12mn 160/100 72 20 37.6
12:30am 160/100
2am 180/100
3am Slept
4am 160/100 78 18 36.4

January 7, 2012
Time Blood Pressure Pulse Rate Respiratory Rate Temperature
8am 100/80 70 20 37
12nn 120/80 75 18 36.5
4pm 130/80 78 24 36.3
8pm 140/80 76 24 36.8
 12mn 120/60 90 26 36.4
4am 120/70 80 25 36.4

January 8, 2012
Time Blood Pressure Pulse Rate Respiratory Rate Temperature
8am 110/90 84 20 36.5
12nn 100/80 72 16 35.8
4pm 160/90 86 24 36.3
5pm 140/90
8pm 140/90 84 22 37.4
12mn 170/100 89 19 37.5
4am 140/70 73 23 36.3

January 9, 2012
Time Blood Pressure Pulse Rate Respiratory Rate Temperature
8am 140/90 82 23 37.4
12nn 140/90 76 24 37.0
4pm 110/70 68 24 37.2
8pm 130/90 70 24 37.1
12mn 130/70 85 22 36.2

January 10, 2012

Time Blood Pressure Pulse Rate Respiratory Rate Temperature
8am 140/90 75 20 37.0
12nn 140/80 78 22 37
 Intake and Output

Date Time Oral IVF Blood Total Urine Vomitus Stool Total Balance
(cc) (cc) (cc) (cc) (cc) (cc)
1-4-12 6-2 100 250 - 350 300 - - 300 50
2=10 500 400 - 900 900 - - 900 0
10-6 - 500 - 500 500 - - 500 0
Total 600 1150 - 1750 1700 - - 1700 50
1-5-12 6-2 300 650 - 950 900 - - 900 50
2-10 400 600 - 1000 900 - - 900 100
10-6 250 550 - 800 500 - - 500 300
Total 950 1800 - 2750 2300 - - 2300 450
1-6-12 6-2 - 400 - 400 500 - - 500 -100
2-10 300 200 - 500 800 - - 800 -300
10-6 - 700 - 700 500 - - 500 200
Total 300 1300 - 1600 1800 - - 1800 -200
1-7-12 6-2 200 800 - 1000 1000 - - 1000 0
2-10 200 200 - 400 900 - - 900 -500
10-6 875 800 - 1675 700 - - 700 975
Total 1275 1800 - 3075 2600 - - 2600 475
1-8-12 6-2 350 600 - 950 1000 - - 1000 -50
2-10 600 650 - 1250 1000 - - 1000 250
10-6 350 300 - 600 500 - - 500 100
Total 1250 1550 - 2800 2500 - - 2500 300
1-9-12 6-2 700 800 - 1500 900 - - 900 600
2-10 500 300 - 800 900 - - 900 -100
10-6 - - - - - - - - -
Total 1200 1100 - 2100 1800 - - 1800 300
1-10- 6-2 400 150 - 550 900 - - 900 350
12
IV. ANATOMY AND PHYSIOLOGY

Pancreas
Is a gland organ in the digestive system and endocrine system of vertebrates. It
is both an endocrine system gland producing several important hormones including
insulin, glucagon, and somatostatin as well as an exocrine gland. Secreting pancreatic
juice containing digestive enzymes that assist the absorption of nutrients and the
digestion in the small intestine. These enzymes help to further break down the
carbohydrates, proteins and lipids in the chime.
Anatomy of the Pancreas
The pancreas is an elongated, tapered organ located across the back of the
abdomen, behind the stomach. The right side of the organ (called the head) is the
widest part of the organ and lies in the curve of the duodenum (the first section of the
small intestine). The tapered left side extends slightly upward (called the body of the
pancreas) and ends near the spleen (called the tail).
The pancreas is made up of two types of tissue:
1.) Exocrine Tissue
The exocrine tissue secretes digestive enzymes. These enzymes are
secreted into a network of ducts that join the main pancreatic duct, which runs
the length of the pancreas.

2.) Endocrine Tissue

The endocrine tissue, which consists of the islets of Langerhans (hormone
production and secretion), secretes hormones into the bloodstream.
Function of the Pancreas

The pancreas has digestive and hormonal functions:

The enzymes secreted by the exocrine tissue in the pancreas help breakdown
carbohydrates, fats, proteins and acids in the duodenum. These enzymes travel down
the pancreatic duct into the bile duct in an inactive form. When they enter the
duodenum, they are activated. The exocrine tissue also secretes bicarbonate to
neutralize stomach acid in the duodenum. These pancreatic enzymes include:
1. Amylase – digest the remaining complex carbohydrates into sugar – mostly
complex. Complex sugars are then further broken down into their individual
components sugars in the small intestine:
 Maltose (glucose + glucose) is acted on by maltase and broken down into
two molecules of glucose.
 Sucrose (glucose + fructose) is acted on by sucrose and broken down
into glucose and fructose.
 Lactose (glucose + galactose) is acted on by lactase and broken down
into glucose and galactose.
2. Trypsin, Chymotrypsin and Elastase are digest proteins.
3. Lypase digest triglycerides into fatty acids and monoglycerides.
4. Nucleases – are pancreatic enzymes that reduce DNA and ribonucleic acid to
their components nucleotides.
5. Secretin – initiate the release of a watery pancreatic solution that contains a
large amount of HCO3.
6. Cholecystokinin – stimulates the pancreas to release an enzyme rich solution.
The hormones secreted by the endocrine tissue in the pancreas are insulin and
glucagon (which regulate the level of glucose in the blood) and somatostatin (which
prevents the release of the other two hormones)
VI. LABORATORY AND DIAGNOSTICS

COMPLETE BLOOD COUNT (CBC)

The complete blood count or CBC test is used as a broad screening test to check
for such disorders as anemia, infection, and many other diseases.

NAME: Z.V.O.
GENDER: FEMALE
AGE: 65 YEARS OLD
DATE REQUESTED: January 3, 2012

RESULT NORMAL INTERPRETATION SIGNIFICANCE

VALUE

Hemoglobin 134 120-170 NORMAL

Hematocrit 0.39 0.37-0.54 NORMAL

RBC count 4.47 4.0-6.0 NORMAL

Indicates
WBC count 16.20 4.5-10.0 INCREASED infection

DIFFERENTIAL COUNT
Indicates
Neutrophils 0.75 0.50-0.70 INCREASED infections

Lymphocytes 0.25 0.20-0.40 NORMAL

-
Monocytes 0.0-0.5 NORMAL
-
Eosinophiles 0.0-0.4 NORMAL
-
Basophiles 0.0-0.1 NORMAL

STABS

MCV 86.70 87+-5 NORMAL

MCH 29.90 29+-2 NORMAL

MCHC 34.50 34+-2 NORMAL

Due to bacterial
Platelet count 487 150-450 INCREASED infection
 URINALYSIS

The urinalysis is used as a screening and/or diagnostic tool because it can help
detect substances or cellular material in the urine associated with different metabolic
and kidney disorders. It is ordered widely and routinely to detect any abnormalities that
require follow up.

NAME: Z.V.O
GENDER: FEMALE
AGE: 65 YEARS OLD
DATE REQUESTED: January 3, 2012

RESULT NORMAL INTERPRETATION SINIFICANT

VALUE
Straw to Dark
Color: Yellow Yellow NORMAL

Transparency: Slightly Turbid Clear-Hazy NORMAL

Reaction (pH): 5.0 5-8.5 NORMAL

Indicate of
Glucose: Positive Negative ABNORMAL high blood
sugar levels
and diabetes
Indicates that
Ketones: Positive Negative ABNORMAL the body is
using fats
rather than
carbohydrates
for energy

Specific 1.015 1.003-1.029 NORMAL

gravity:
Indicates
Pus cells: 40-50/hpf 2-3/hpf INCREASED presence of
infection
 BLOOD CHEMISTRY

Blood chemistry tests are often ordered prior to surgery or a procedure to

examine the general health of a patient. This blood test, commonly referred to as a
Chem 7 because it looks at 7 different substances found in the blood, is routinely
performed after surgery as well.

NAME: Z.V.O
GENDER: FEMALE
AGE: 65 YEARS OLD
DATE REQUESTED: January 3, 2012

RESULT NORMAL INTERPRETATION SIGNIFICANCE

VALUE

BUN 15.61 9-23 NORMAL

Creatinine 1.13 0.5-1.2 NORMAL

SGPT-ALT 11.27 0-31 NORMAL

Sodium 138.00 137-147 NORMAL

Indicates
Potassium 3.60 3.5-5.5 DECREASED Hypokalemia
Due to poorly
HbA1c 8.96 4.8-5.9 INCREASED control
diabetes
 HEMOGLUCO TEST

Blood glucose monitoring allows a person to know their blood glucose level at
any time and helps prevent the immediate and potentially serious consequences of very
high or very low blood glucose. Monitoring also enables tighter blood glucose control,
which decreases the long-term risks of diabetic complications.

NAME: Z.V.O
GENDER: FEMALE
AGE: 65 YEARS OLD
DATE REQUESTED: January 3, 2012

Date Result Normal result Interpretation

January 4,2012 173 mg/dl 100-125mg/dl Indicates high

glucose level

January 5,2012 157 mg/dl 100-125mg/dl Indicate high

glucose level
VII. Medical Management
Date and Time Doctor’s Order Rationale
January 4, 2012 Admit to ROC under the
2:35 am servicesof Dr. M
Secure consent for
HGT= 173mg/dl admission
Diabetes Diet A diabetes diet means eating a variety
Diabetic foot L of nutritious foods in moderate amounts
DM type 2 and sticking to regular mealtimes.
Uncontrolled Focus on the healthiest carbohydrates.
Fiber can decrease the risk of heart
BP=140/100 disease and help control blood sugar
PR=76 levels.
RR=24 IVF: PNSS 1L x 16 It is used because it has a little to no
T=36.3 effect on the tissues and make the
Wt=61.7 kg person feel hydrated preventing
hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.
Diagnostic Test: It is used as a broad screening test to
CBC check for such disorders as anemia,
infection, and many other diseases.

UA It is used as a screening and/or

diagnostic tool because it can help
detect substances or cellular material in
the urine associated with different
metabolic and kidney disorders. It is
ordered widely and routinely to detect
any abnormalities that require follow up.
BUN The nitrogen component of urea,
B.U.N. is the end product metabolism
and its concentration is influenced by
the rate of excretion. Exercise protein
intake, intestinal bleeding, exercise or
heart failure can cause increase.
Decreased levels may be due to a poor
diet, malabsorption, liver damage or low
nitrogen intake.

CREA Creatinine is the waste product of

muscle metabolism. Its level is a
reflection of the bodies muscle mass.
Low levels are sometimes seen in
kidney damage, protein starvation, liver
disease or pregnancy. Elevated levels
 are sometimes seen in kidney disease
due to the kidneys job of excreting
Creatinine, muscle degeneration, and
some drugs involved in impairment of
kidney function.

HGT It is a test that measures the

concentration of glycosylated
hemoglobin in the blood. This is the
amount of hemoglobin bound to
glucose. The test is used to determine if
the blood sugar level has been high for
a long time. There would be very little
glycosylated hemoglobin if it hasn't.
Treatment: To prevent further infection from
1. Metronidazole patients wound.
500mg/tab q8
2. Metoprolol Anti-hypertensive. Maintenance
100mg/tab OD at medicine.
8pm
3. Metformin Anti-diabetic medicine
500mg/tab TID
4. Imdur 60mg/tab Anti-hypertensive medicine.
OD
Refer to Dr. T for co-
management
VS q4; I and O q shift To properly monitor the condition of the
patient.
Notify AP
Refer Accordingly
Dr. Tan informed of
referral
Start Humulin N 20u BB Anti-Diabetic medicine.
10u BS SQ
HGT monitoring pre- To properly monitor the blood glucose
meals q6 of the patient. This will also serve, as a
basis in how many units of anti-diabetic
medication should be administered.
Continue Imdur Anti-hypertensive medicine.
Refer HGT results HGT results that are too high or too low
should be referred to the AP for proper
management procedure.
January 4,2012 Sliding scale of Humulin The sliding scale will serve as a basis
9am N SQ as follows: on how many units of anti-diabetic
medication should be administered to
the patient for proper management.
 HGT Units
200-250 2
251-300 4
301-350 6
351-400 8
>400 10

January 4, 2012 IVF: PNSS 1L x 16 It is used because it has a little to no

10:35am effect on the tissues and make the
person feel hydrated preventing
hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.

A low sodium diabetic diet can be

January 4, 2012 Diabetic/Low Salt/Low helpful even to people who do not have
2:55pm fat diet diabetes. Eating a proper diet can also
help reduce your risk of developing
diabetes. In a diabetic diet low sodium
and low calorie foods can help you
maintain a healthy weight. Being
overweight is a serious risk factor for
diabetes.
IVF PNSS 1L x 16 It is used because it has a little to no
effect on the tissues and make the
person feel hydrated preventing
hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.
Humulin N 25u Anti-diabetic medicine.
Continue Simvastatin Anti-lipidemic drug.
Continue Imdur Anti-hypertensive drug.
Continue present
management
January 4, 2012 Paracetamol 500mg q4 To lower down fever of 38.4 C
7pm for fever
January 4, 2012 For metatarso- Metatarsophalangeal joint
8:30pm phalangeal joint disarticulation is a procedure done to
disarticulation remove the toe of a diabetic patient;
this is because of Atherosclerosis
(thickening of the artery walls are
thicken due to the build up of
cholesterol and fatty acids).
 Secure consent
Refer
January 5, 2012 IVF to ff: pNSS 2Lx24 It is used because it has a little to no
1pm effect on the tissues and make the
person feel hydrated preventing
hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.
January 5, 2012 Tramadol 50mg IV q8 To alleviate patient pain.
2:50pm
January 5, 2012 Schedule for OR
tomorrow 9am
Notify OR
January 6, 2012 Post-OR orders
12nn - diabetic diet
- continue
medication
- keep right foot - To maintain proper circulation on the
elevated with 1-2
pillows
- refer
Shift IV PNSS to q 8 It is used because it has a little to no
effect on the tissues and make the
person feel hydrated preventing
hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.
January 6, 2012 Shift IV PNSS 1L to 12 It is used because it has a little to no
1:30pm effect on the tissues and make the
person feel hydrated preventing
hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.
January 6, 2012 IVF to ff: PNSS 1L x 12 It is used because it has a little to no
9:20pm effect on the tissues and make the
person feel hydrated preventing
hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.
January 6, 2012 Catapres 25mg Anti-Hypertensive drug.
11:55 pm sublingual for BP=150
BP = 160/100 BP monitor
January 7, 2012 PNSS 1L x 12 It is used because it has a little to no
8:18am effect on the tissues and make the
person feel hydrated preventing
hypovolemic shock or hypotension.
 Used specially on diabetic patient
because it contain no dextrose.
January 7, 2012 D/C Humulin N/ Hgt Anti-diabetic medication.
9:35am Start
- Gliclazide 30mg Anti-diabetic medication.
P.O
- Metformin 500mg Anti-diabetic medication.
BID

- Lozartan 50mg Anti-hypertensive drug.

OD 7am

- Amlodipine 5g Anti-hypertensive drug

OD 7pm

- Metoprolol 50mg Anti-hypertensive drug.

½ tab BID

- Simvastatin Anti-lipidemic drug.

January 8, 2012 IVF to follow PNSS 1L x It is used because it has a little to no
4:40pm 12 effect on the tissues and make the
person feel hydrated preventing
hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.
January 8, 2012 Debonement of necrotic It is done to remove the bone and
9:30pm tissues done necrotized tissue on the affected part of
the body.
Oral Ciprobay 500mg Anti-biotic drug.
tab q12

Continue other meds

January 9, 2012 IVF to follow PNSS 1L x It is used because it has a little to no
2:30pm 12 (2 cycles) effect on the tissues and make the
person feel hydrated preventing
hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.
January 10, 2012 IVF to follow PNSS 1L x It is used because it has a little to no
16 effect on the tissues and make the
Trental 400mg tab PO person feel hydrated preventing
OD hypovolemic shock or hypotension.
Used specially on diabetic patient
because it contain no dextrose.