Managing DKA and HHS
Medgeeks with Andrew Reid
Medgeeks
4.8 • 997 Ratings
🗓️ 19 July 2018
⏱️ 12 minutes
🧾️ Download transcript
Summary
In last weeks episode, we discussed the differences between DKA and HHS. Today, we'll be sharing how to manage these two diseases.
If you missed last weeks episode, you can listen to that here: https://medgeeks.co/podcast/
We had that 35 year old female with type 1 DM on insulin complaining of burning with urination, followed by a few days of nausea, vomiting, abdominal pain, and poor PO intake.
Labs revealed DKA: glucose 480, HA1c 10.5%, positive urine/serum ketones, creatinine 1.6, and anion gap of 25.
ABG showed ph of 7.25, PCO2 of 28, bicarb of 12, and O2 of 90 on room air. This is a metabolic acidosis with respiratory compensation.
(We'll also show you a shortcut on how to calculate the expected compensation).
Sodium was 136.
UA was positive for infection.
Vitals: BP 83/45 - MAP of 58, HR 110, 100.8 F.
Management can be grouped into 3 categories:
1. fluids and electrolytes
2. insulin
3. monitor
Today, we'll break this all down for you. Enjoy!
-
Our goal at Medgeeks is to help you live the life you want to live as you navigate a career in medicine.
This looks different to everyone, which is why we take such a personalized approach.
Whether you want to ...
- Stop taking your work home
- Have the skillset to work autonomously
- Improve your work life balance
https://medgeeks.co/about-us
-
Check out our free Facebook group, where we share daily clinical pearls, advice, and practice changing updates:
-
This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing standard of care in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast, video, or blog.
Transcript
Click on a timestamp to play from that location
| 0:00.0 | Team, Sacklavner here from med geeks. |
| 0:04.0 | Welcome back. |
| 0:05.0 | Today, we're going to talk about the management of a D-K-HHS patient. |
| 0:10.0 | Last week, we talked about the evaluation. |
| 0:12.0 | This week, I want to tell you how to treat that patient. |
| 0:15.0 | So we had that 35 year old female, history of type 1 diabetes on insulin, complaining of burning with urination, followed by a few days of nausea |
| 0:24.8 | vomiting abdominal pain and poor PO intake. Labs that were done revealed D. K. |
| 0:31.2 | So to review she was hyperglycemic to 480 A1C at 10.5. Her urine and serum |
| 0:39.0 | ketones were positive. Her cratineen was 1.6, so she had an AKI, likely due to dehydration. |
| 0:46.2 | An anion gap acidosis. Gap was 25 and bicarb of 12. A, B, G showed a pH of 7.25, a PCO2 of 28, bicarb of 12, and an 02 of 90 and that was on room air. So kind of to break this down a little further, pH of 7.25, that's acidemic. Her bicicard was 12 so this is a metabolic acidosis |
| 1:16.9 | if we look at her CO2 which is 28 we can use winter's Formula to determine if there's any compensation going on. |
| 1:26.6 | So if we use Winter's Formula, that's 1.5 times her bycard which is 12 |
| 1:37.0 | plus 8 that equals 26 Her PCO2 is 28 so the expected PCO2 of 26 |
| 1:42.0 | plus or minus 2 gives us 28 so her CO2 has fully compensated for that |
| 1:47.7 | drop in her bycar so yeah that seems like a lot of math and trust me there's multiple days where I have an |
| 1:54.5 | acidotic patient that's metabolically driven and I just don't have the mental capacity to |
| 1:59.6 | calculate winter's formula. |
| 2:01.6 | So a quick shortcut for you is you look at the last two digits of |
| 2:06.2 | the pH so in our case 7.25 so we'll say 25 the last two digits the expected PCO2 for compensation |
| 2:16.1 | Should be equal to that plus or minus two. So if you think about it 2-5 was the last two digits of the pH. Our patient's CO2 is 28. So 25 plus 2 is 27, so we're pretty close to 28. So that's a quick and dirty way of looking for the expected PCO2 compensation. |
| 2:39.0 | However, easy, but if the expected PCO2 was higher or lower, then you may be scratching your head, |
| 2:47.6 | but this just tells you that there's another primary process going on. |
... |
Please login to see the full transcript.
Disclaimer: The podcast and artwork embedded on this page are from Medgeeks, and are the property of its owner and not affiliated with or endorsed by Tapesearch.
Generated transcripts are the property of Medgeeks and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.
Copyright © Tapesearch 2026.