Good day. Dominic Barfield here and this is the IvyC Clinical Podcast. Thank you for listening

and thank you for subscribing on your smartphone or generic fruit brace device. Really grateful

for you taking the time to download and listen to this obviously podcast. We don't know so much

from return. We're incredibly grateful if you popped at Apple Podcasts, Acast and leave us a review.

Obviously a five-star review would be great and we really appreciate if you'd just take a couple minutes for time to leave us a review there.

So joining Brian and myself in the studio, we're going to talk to the wonderful Tom Greensmith,

who is our cardiothoracic profusion fellow in staff condition in ECC,

and we thought we'd have a chat with him, which was a suggestion, actually,

in one of the reviews about diabetic ketoacetacetacis.

So thank you, Tom, for joining us in the in the studio hello thank you very much for having me well you know we we try

occasionally so um so thought a term like diabetic keto acedasis it's supposed to get people

probably on point listening so we are we can have patients that are diabetic, ketotic and acedotic,

and they can have a spectrum of presentation.

Would you agree with that?

Yes, absolutely.

I mean, obviously, quite a lot of them that are DCA won't be coming to see us,

especially if they're eating and otherwise okay, but just a little bit groggy and a bit rubbish.

Right the way through to those patients that are utterly moribund that you can barely find a pulse have been maybe unwell for days and it's been missed for various reasons.

And of course, those are the ones where extremely careful management is going to be required

rather than just a slight adjustment to their sort of current insulin protocol

and a bit of close watching at home sort of thing.

But at the bad end of the spectrum,

...