Why Incrementum Matters Globally

• Appropriate Use: Focus on specific instances like metabolic acidosis with renal failure or severe metabolic cases with tox patients (e.g., salicylate or TCA overdose).
• Emphasis on Patient-Centric Care: Treat the patient, not the number; avoid harmful overreliance on bicarb based solely on lab results

• Balanced Solutions: Preferenced over normal saline to prevent hyperchloremic acidosis.
• Potassium Management: Oral potassium is effective and should be utilized, challenging the myth of impaired gastric absorption in DKA.
• Squid Protocol: Usage of ultra-rapid insulin subcutaneously as an alternative to insulin drips in mild to moderate DKA cases.
• We covered this topic before on REBEL EM. Check out the post here and the podcast here

• Hypotension Insights: Do not attribute sudden hypotension solely to medication; prioritize ruling out tamponade or cardiogenic shock.
• Ultrasound Utilization: Essential tool for detecting complications like tamponade or low EF due to myocardial infarction or aortic valve regurgitation.
• Controlled Pericardial Drainage: Crucial technique to stabilize hemodynamics without increasing mortality, avoiding extensive fluid removal.
• Here’s a helpful algorithmic infographic to reference for aortic dissection patients:
• Image Courtesy of Dr. Mark Ramzy, DO (@MRamzyDO) 

Hyperkalemia

• Not every patient needs calcium. Dont just give it prophylatically, only those with EKG changes should get it and get enough of it.
• Give an appropriate dose of your other medications. That includes giving 10 units of insulin and 2 amps of dextrose 50. One when they get the 10 units of insulin and the other 30 minutes later
• Patients may be dehydrated, dont give them furosemide or diuretics. Those patients need fluid to help perfuse their kidneys and eliminate potassium
• Here’s the Algorithm George mentioned in the episode
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• Here’s a REBEL REVIEW breaking down the different electrolytes in each of the types of fluids: