Preview Mode Links will not work in preview mode

Ridgeview and the Ridgeview Continuing Medical Education Program are proud to present the Ridgeview Podcast: CME Series; a quality, portable and on-demand continuing medical education, that features a variety of exceptional physicians, providers and other staff from Ridgeview and it's affiliates. Hosts of the program are Fred DeMeuse, PA-C, Jason Hicks, PA-C, and Leah Radde, RN. Thanks for tuning-in, downloading and listening! 

 

DISCLOSURE ANNOUNCEMENT 

The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview & Ridgeview Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 

It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.

Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.

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!

Objectives:
  Upon completion of this podcast, participants should be able to:

  • Define diabetic ketoacidosis.
  • State the differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
  • Summarize how to diagnose and treat diabetic ketoacidosis.

CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org.

To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation.

CME Evaluation

(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) 

DISCLOSURE ANNOUNCEMENT 

The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws. 

It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.

Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.

Thank-you for listening to the podcast.

SHOW NOTES: 
*See the attachment for additional show information.
  
DKA: Deficit of insulin
- Typical scenario
    - Insulin deficienty + counterregulatory hormones
    - Catabolic state
    - Gluconeogensis
    - Glycogenolysis
    - Elevated blood sugar causes concomitant osmotic
      diuresis

DKA: 3 Parts
- Ketones (ketonemia)
- Hyperglycemia (lack of insulin)
- Acidosis (Anion gap Metabolic Acidosis)

Presentation
- 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

Work-up
- Basics
CBC with differential; metabolic panel, serum ketones, blood gas, urine analysis, plasma osmolality
- Evaluation:
Elevated WBC;  elevated anion gap;  electrolyte abnormalities;  Chest x-ray

Results
- Potassium (hold insulin if K was 3.4 or below)
- Hyponatremia
- Bicarb
- Anion gap
- Normal to elevated calcium
- BUN greater than creatinine ration
- Elevated creatinine
- Elevated WBC due to catecholamines and stress response
- Hgb/platelets
- Urine

Treatment
- Fluids
- Potassium
- Insulin

Transition to baseline
- 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.