Apr 8, 2022
In this podcast,Dr. Greg Giese, an internal medicine physician with Ridgeview talks about diabetic ketoacidosis (DKA). More specifically Dr. Giese will discuss the pathophysiology, initial assessment findings and diagnosis of DKA, along with addressing the differences between diabetic ketoacidosis (DKA) and hypersmolar hyperglycemic state (HHS), and treatment options for DKA patients.
Enjoy the podcast!
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DKA: Deficit of insulin
- Typical scenario
- Insulin deficienty + counterregulatory hormones
- Catabolic state
- Elevated blood sugar causes concomitant osmotic
- Ketones (ketonemia)
- Hyperglycemia (lack of insulin)
- Acidosis (Anion gap Metabolic Acidosis)
- Critically ill individual on set in 24-48 hours
- Kussmaul respirations
- Other causes (infections, UTI, pneumonia, skin
infections, MI, drugs,)
- Altered mental status
- HHS: Hyperosmolar hyperglycemic state
CBC with differential; metabolic panel, serum ketones, blood gas, urine analysis, plasma osmolality
Elevated WBC; elevated anion gap; electrolyte abnormalities; Chest x-ray
- Potassium (hold insulin if K was 3.4 or below)
- Anion gap
- Normal to elevated calcium
- BUN greater than creatinine ration
- Elevated creatinine
- Elevated WBC due to catecholamines and stress response
- Discontinue insulin when anion gap metabolic acidosis closed and able to take oral nutrition
- Bridge, start subcutaneous long acting insulin, stop insulin drip 1-2 hours later.
Thanks for listening.