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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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.
Uncovering DKA Triggers
- Actively seek the underlying trigger for DKA, as it's often the most dangerous aspect.
- Common triggers include medication issues, ACS, stroke, sepsis, steroids, and pregnancy.
Abdominal Pain in DKA
- Evaluate abdominal pain in DKA patients carefully, as it can be tricky to discern the cause.
- Resuscitate with fluids and reassess before imaging, unless there are clear surgical signs.