Welcome back to the EM Basic Podcast. Today we'll be discussing the management of DCA and children.

I'd like to start by introducing Zach Hodges.

Hello, everyone. Like you said, my name is Zach Hodges. I'm a pediatric resident at the Medical

College of Georgia. I'm here with Dr. Chris Watson, Associate Professor of Pediatrics here at the

Children's Hospital of Georgia. Dr. Watson is a pediatric intensivist who trained at Johns Hopkins Hospital and served in the Navy prior to joining MCG, where he also now serves as the

PICU Fellowship Program Director. Dr. Watson, how are you today? Hi, Zach. Hey, everyone. I'm really

excited to be here and discussing D.K.A. Diabatic ketoacidosis today with our EM Basic audience.

This is a really common pediatric

presentation in both the emergency room and ICU. So let's jump on in. The framework of the

discussion will be based on the International Society for Pediatric and Adolescent Diabetes

Clinical Practice Guidelines in 2018 for DCAA and hyperglycemic hyperosmolar state. The focus of the

podcast will be on the management of DCAA and we will deferlycemic hyperosmolar state. The focus of the podcast will be on the management

of DCAA, and we will defer the discussion of hyperosmolar state for another time. Let's start with a

clinical case. All right. So you're working a shift in the Peds Emergency Department when an 11-year-old

boy with no significant past mental history is brought in by EMS with nausea, vomiting, abdominal

pain, increased work of breathing,

alter mental status, and increase urine output.

Blood glucose en route was listed as high, with the glucometer being unable to give you a specific

number. Dr. Watson, what are your initial thoughts when evaluating this child with likely new onset

DCA?

So let's start by looking at the clinical findings in this case.

One of the first things we notice is that this patient is presenting with several of the typical

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