Diabetic Ketoacidosis (DKA)

EM Basic

EM Basic LLC

Residency, Student, Medicine, Er, Em, Intern, Health & Fitness, Medical, Education, Emergency

4.6 • 665 Ratings

🗓️ 30 December 2011

⏱️ 21 minutes

🔗️ Recording | iTunes | RSS

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Summary

This is a topic episode on Diabetic Ketoacidosis (DKA). We'll discuss the diagnosis and treatment of this complex disease process and how to avoid pitfalls that can harm the patient. There will also be tons of clinical pearls including treatment of DKA's cousin Hyperglycemic Hyperosmolar State (HHS) and pediatric DKA considerations. Also, you can now follow EM Basic on Twitter- @embasic for news on the latest episodes and anything else interesting that I find related to emergency medicine. This episode is also the debut of a new microphone setup that gives a much higher audio quality for the podcast.

Transcript

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0:00.0	This is Steve Carroll and you're listening to the EM Basic Podcast.
0:04.0	Today we'll be doing a topic podcast on diabetic ketoacidosis or DCA.
0:09.0	We'll also talk briefly about hypersmole or hyperglycemic state or HHS since it's part of the DQA spectrum.
0:16.0	We'll go over how to make the diagnosis and how to manage these sick patients while they're in the emergency department. We'll also go over a few pearls about pediatric DKA management.
0:25.6	Before we get started, just a quick announcement that you can now follow EM Basic on Twitter.
0:29.9	Just search for EM Basic, all one word, and you'll find it. I'll tweet when new episodes are posted
0:34.7	and with anything else interesting I find on the EM interwebs. I also want to thank Rob Warman from the ERCast podcast for the recent mention of
0:42.2	EM Basic on his podcast on Febrile Infants. So welcome to any new listeners that may be out there.
0:47.5	I hope you like what you hear. Also one more thing. I just got a new microphone set up going
0:51.9	and to answer a few questions, yes, it was a Christmas
0:54.7	present, and yes, I am a giant nerd. All that being said, I hope you enjoy the improved audio
0:59.5	quality. As always, this podcast doesn't represent the views or opinions of the U.S. Army,
1:04.0	the Department of Defense, or the Shawshack EM residency. So let's get started. The first thing
1:09.6	we need to talk about is the definition of DCA and HHS.
1:12.6	In general, you'll see DQA in Type 1 Diabetics and HHS and Type 2 Diabetics, but type 1 diabetics can also get HHS and type 2 diabetics can get DQA.
1:23.6	I'm sure just about everyone knows this, but just a quick reminder that type 1 diabetics have an
1:28.8	absolute deficiency of insulin. When they don't have sufficient insulin, the body burns fat for energy
1:34.0	which produces ketones. I promise that this will be quick, but if you go back to organic chemistry,
1:39.5	ketone bodies have hydrogen ions that dissociate near the body's natural pH of 7.4, so therefore this
1:45.7	causes acidosis. And that's about all I remember from organic chemistry. Thank you very much.
1:51.2	On the other hand, type 2 diabetics have a resistance to the action of insulin, so as a
1:55.3	consequence, they do not produce ketone bodies because they still have circulating insulin.
	...

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