Diabetic Ketoacidosis (DKA)

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 2 April 2017

⏱️ 11 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

The blood sugar is NOT the emergency- Acidosis, Hypokalemia, and Dehydration are!!!

Signs and Symptoms

* Vomiting* Abdominal pain* Polydipsia* Polyuria

Step 1: Test for DIABETIC-KETO-ACIDOSIS

* Diabetes* Blood sugar* Typically notably elevated (>250 mg/dL)* Can be normal in certain circumstances* Ketones* Easiest test is a urinalysis* Serum ketones also can be obtained* Acidosis* Blood gas (arterial or venous)* pH <7.3

Step 2: Check Potassium Level

* Patients frequently depleted of whole body potassium* Insulin administration will causes further drops in serum potassium level

Step 3: Replace Potassium

* If potassium <3.3, do not give insulin* Replace potassium prior to insulin* If potassium >3.3 but <5.5* Consider supplementing potassium at this point* May continue insulin

Step 4: Give Fluids

* Adult patients are frequently 3-6 LITERS depleted* 20 ml/kg NS during first hour

Step 5: Start an Insulin Drip

* This accomplishes 2 things…* It decreases blood sugar* It also decreases acid production

Additional Reading

* Peds H- Hyperglycemia and Hypoglycemia (EM Clerkship)* DKA Myths (REBEL EM)

Transcript

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0:00.0	Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of
0:07.1	endless charting once you become a doctor? Do you think that doctors should be spending more
0:11.9	time with our patients and less time mindlessly writing notes? Freed AI is the product for you. It is a
0:20.4	secure, hippocompliant scribe that anybody can use.
0:24.7	Focus your energy on what matters, providing good patient care.
0:29.5	Use coupon code EM50 to save 50% the first month you try it,
0:34.1	and you can cancel at any time if you decide it's not right for you. You can learn more at
0:39.3	www.gitfreed.a.i. Hello, bed students. My name is Zach Olson and thank you for downloading
0:50.9	this week's episode of the EM Clerkship Podcast.
0:57.0	Our topic this week is dedicated to Andre out of SGU, who wrote me an email requesting an
1:03.3	episode on hyperglycemia in DKA a few months ago.
1:08.7	Sorry it took me a little bit to get to this, Andre, but this episode's for you.
1:19.0	Okay, everybody, it's a 32-year-old male, had a chief complaint of fever cough and diffuse
1:23.9	abdominal pain, emesis times two, slightly confused on scene, had poor skin
1:29.3	Turgar, does have a history of type 1 diabetes, has been taking his medication according
1:34.0	to the family.
1:35.0	We did give a 1-liter bolus initial on scene.
1:37.6	He's got a BP of 160 over 90, pulse of 110, respirations are at 40, and our glucose meter
1:43.1	only red high, So, unless you
1:44.7	have any questions, we'll leave you to it. Okay. Thank you.
1:53.1	D.K.A. Diabetic ketoacidosis. If you only remember one thing today, the sugar doesn't matter.
2:09.3	The sugar is not the problem. In fact, the blood sugar is like the least important part of DCA
	...

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