Emergency Medicine Cases Ep 146 DKA Recognition and ED Management
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Sep 29, 2020 In this engaging discussion, Dr. Melanie Baimel, an expert in electrolyte disorders, Dr. Bourke Tillman, a critical care physician, and Dr. Leeor Sommer, an emergency physician, tackle the complexities of diabetic ketoacidosis (DKA). They emphasize the importance of identifying DKA triggers, the misconceptions around normal pH readings, and the critical role of diligent monitoring. The conversation also covers protocols to improve outcomes, challenges of intubating DKA patients, and the necessity of fluid resuscitation, providing invaluable insights for emergency medicine professionals.
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DKA Recognition
- Consider DKA in diabetic patients with vomiting, abdominal pain, tachycardia, and tachypnea.
- Rely on history, physical exam, and lab values (including ketones) for diagnosis.
Normal pH in DKA
- DKA can present with a normal pH due to mixed acid-base disturbances.
- Don't rule out DKA based on normal pH; consider the base deficit, anion gap, lactate, and other causes.
Ordering Ketones
- Always order serum ketones for potential DKA patients, even if initial labs aren't obvious.
- Don't lock onto a diagnosis early; consider other possibilities if blood work is abnormal.