DKA vs HHS
Medgeeks with Andrew Reid
Medgeeks
4.8 • 997 Ratings
🗓️ 12 July 2018
⏱️ 11 minutes
🧾️ Download transcript
Summary
Today, we're going to talk about the evaluation of your diabetic patient who walks into your clinical with a glucose which is unable to be read (>500).
A 35 year old female with type 1 DM on insulin arrives to the ER for evaluation after being referred by her PCP.
The patient complains of burning with urination x3 days, followed by nausea, vomiting, and abdominal pain with poor PO intake.
Because she hasn't been eating regularly, she didn't take her insulin last night.
When a patient comes in with this presentation, we need to be thinking DKA (diabetic ketoacidosis) or HHS (hyperosmolar hyperglycemic state).
Today, Zach will run through this patient with you so that you can decipher between the two disease processes.
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Transcript
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| 0:00.0 | Team, Zach, |
| 0:02.0 | Zach here for Metgeaks. |
| 0:04.0 | Today, we're going to talk about the evaluation of your diabetic patient that walks into your clinic |
| 0:10.0 | with a point-of-care glucose read that's above 500, unable to read, aka go to the emergency |
| 0:16.3 | room. |
| 0:17.3 | So a 35 year old female with a history of type 1 diabetes on insulin arrives to the emergency room for evaluation |
| 0:25.4 | from our PCP office. The patient complains of burning with urination for the |
| 0:30.6 | past few days followed by nausea, vomiting, and abdominal pain with poor PO intake over the past couple days. |
| 0:38.0 | She measured her glucose at home. It was high so she went to her primary care office and then ultimately came to the |
| 0:45.9 | emergency room. She states that she hasn't really eaten or drank anything in the |
| 0:52.3 | past few days. |
| 0:53.6 | So she didn't take her insulin last night. |
| 0:58.1 | Didn't want to bottom herself out. |
| 1:00.0 | Normally she takes 21 units, Lantis at night, with 7 units for male coverage during the day. |
| 1:06.4 | You repeat the point of care glucose on arrival and once again it reads above 500, so what do we do next? Well, when I have a patient with a history of type 1 diabetes, comes |
| 1:17.3 | in with hyperglycemia, I'm thinking two things. D.K.A. diabetic ketoacidosis, or HHS, hyper-osmolar, hyperglycemic state. |
| 1:29.6 | Simply put, DCA is a state of hyperglycemia with ketoacidosis, |
| 1:36.2 | remember it says it in the name, |
| 1:39.1 | versus HHS which is a state of hyperglycemia without ketoacidosis. |
| 1:47.0 | So before I see patients with this kind of presentation, |
| 1:51.0 | I like to think about what are the factors that could lead to |
| 1:54.6 | D.K. or HHS to give me a guide for my interview with the patient. |
... |
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