EM Fundamentals

APPROACH TO DIABETIC KETOACIDOSIS

Goals and Objectives Goals Resident will be comfortable with initial evaluation and basic management of patients with diabetic ketoacidosis Learning Objectives For patients presenting with diabetic ketoacidosis, resident will be able to: List criteria for diagnosing DKA List common presenting signs and symptoms of patients in DKA List diagnostic tests commonly indicated in the work-up of patients with DKA Fingerstick glucose CBC with differential BMP / Mg / Phos VBG Serum ketones UA Infectious work-up (as indicated) Name common electrolyte abnormalities and approach to treatment Sodium Potassium Serum Total-body Magnesium Phosphate Name common acid-base abnormalities and approach to treatment Name and describe three pillars of DKA management Volume repletion Insulin therapy / glucose management Electrolyte management Describe appropriate initial fluid resuscitation for Pediatric patients Adult patients Describe appropriate insulin therapy: Timing / conditions for initiation  Type / route / dose of insulin Describe appropriate electrolyte repletion: Thresholds for repletion Route / dose of therapy Name the tests used for continued monitoring and appropriate intervals for testing Glucose Electrolytes pH Anion Gap Resident will be able to appropriately disposition patients diagnosed with DKA

Recommended Resources Prior to Conference DKA Guidelines (UChicago MEROps) Peds DKA Guidelines (UChicago Peds Chiefs) Diabetic Emergencies (EBMedicine) (pdf) Additional Resources General / Review Diabetic Emergencies (EBMedicine 2004) (pdf) DKA/HHS Review (EM:RAP 2013) DKA Myths (EM:RAP 2013) DKA Myths (EMDocs 2014) Acid-Base Problems in DKA (NEJM 2015) Pediatric DKA Peds DKA Guidelines (UChicago Peds Chiefs) Pediatric DKA (EM:RAP 2011) DKA and Cerebral Edema (EM:RAP 2014)

Original Post by Eric Shappell on 06/12/2015

Last Updated by Eric Shappell on 09/15/2015