Hey folks, Scott Wangart here and this is the M. Critt podcast, today on the podcast,

the critically ill diabetic ketoacidosis patient. Now that's a bit of a misnomer

in that by numbers a lot of them may actually look to be critically ill but most of these patients

aren't that sick and in many hospitals they're all going to the ICU and if you don't have many

ICU beds that's probably a waste of time. These patients can be cleared in the emergency department,

they can be cleared quickly and today we're going to discuss what is I think the optimal

way to do that. Now before we get into the mix, if you're not already a member of the M. Critt

podcast please consider joining, you'll get the full episodes, not the truncated versions,

you will get access to our forum, you'll get access to the secondary podcast on deeper reflection

and you'll get CME if you want it but what you'll really get is the opportunity to be a better

recess and critical care doctor. This will bridge the gap between what training you were given

and where you want to be as a resuscitationist. So M. Critt.org slash join. I guess the first

thing to speak about is what your goal is in treating a sick decay patient and that's what we're

talking about today. We're talking about sick decay, not the, you know, they have just the slightest

bit of ketones and their sugar is 450 and you know they're going to clear very quickly. Those

patients probably should just get subcutaneous insulin, they don't even need an insulin drip and

you check them a few hours later and they should be done, you know, you might need one more round,

you know, you could give LisPro Q1 hour, you just give it, you check labs, maybe you give it one

more time and they should clear. We're not talking about today. Today we're talking about

severe decay and your goal for these patients and your marker of success is to close the gap and

keep it closed. Now, why am I saying this? Well, many endocrinologists base protocols and their

thinking is predicate on the blood sugar and the blood sugar really is not the goal in treating

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