IBCC Episode 1 - DKA

The Internet Book of Critical Care Podcast

Adam Thomas

Foam, Medicine, Health & Fitness, Science, Criticalcare, Medicaleducation

5 • 714 Ratings

🗓️ 6 September 2018

⏱️ 23 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

In this episode, we cover the anatomy of a DKA resuscitation. Check the post out for some juicy pearls.

As always, the pitfalls:

Missing an underlying cause of DKA, especially sepsis. The primary cause of death among patients admitted with DKA isn't the DKA itself, but rather associated conditions (mostly sepsis).
Bolusing large volumes of normal saline will make the patient more acidotic. This is generally not a major problem, but it can be for the patient who starts out severely acidotic at baseline.

Transcript

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0:00.0	Welcome, guys, to the inaugural Internet Book of Critical Care podcast.
0:09.6	I'm Adam Thomas, and the brainchild, the bohemist, the man himself, is with us.
0:14.0	Thanks for tuning in.
0:14.9	This is Josh Varcus.
0:16.1	I'm a pulmonary critical care junkie at the University of Vermont Medical Center in the United States. Nice to speak to you all.
0:22.2	All right to get us started, the anatomy of a DCA resuscitation. A very common problem you're going to
0:27.3	see in the unit and on the wards. And it's really important to have a fundamental understanding of what's
0:32.9	going on here. So today, Josh wanted to go over the definition diagnosis of DCA. Then we're going to
0:37.4	hit you up with eight key points.
0:39.3	Identify and treat an underlying cause.
0:41.3	Insulin infusions.
0:42.3	Get that patient eulemic.
0:44.3	We're going to cover fourth point on crystalloid infusions.
0:46.3	Then we'll go over point number five, starting long acting insulin.
0:50.3	Number six, we'll cover high flow nasal cannula support of that coosmal work of breathing.
0:55.3	Number seven, we'll talk about things to follow while the patient is on their insulin infusion.
0:59.9	And last up, number eight, we'll talk about how to get that patient off the insulin infusion.
1:04.6	All right, let's get started.
1:05.7	So definition of diagnosis of D.K.A. What are the major things we're looking at here, Josh?
1:09.7	So the definition,
1:15.0	there are different definitions floating around in the universe. And my definition is pretty simple.
1:19.7	I think a patient with DCA is someone who has diabetes in an elevated anine gap. One key point here is you do not need an ABG or VBG to diagnose DQ. And also, in my view, the patient
	...

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