EM Cases: HHS Recognition and ED Management
We dive into the recognition and ED management of Hyperglycemic Hyperosmolar State (HHS)!
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dka
Visual Wednesdays: DKA vs HHS
Better late than never…Visual Wednesday on DKA/HHS!
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EM Cases: Pediatric DKA
Learn the key historical and examination pearls to help pick up this sometimes elusive diagnosis, what the value of serum ketones are in the diagnosis of DKA, how to assess the severity of DKA to guide management, how to avoid the dreaded cerebral edema that all too often complicates DKA, how to best adjust fluids and insulin during treatment, which kids can go home, which kids can go to the floor and which kids need to be transferred to a Pediatric ICU.
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EM@3AM: Diabetic Ketoacidosis
A 37-year-old female presents with dysuria, polyuria, polydipsia, and lightheadedness. She has a history of insulin-dependent diabetes but ran out of her glucose strips at home. She has had significant nausea and suprapubic pain. She is tachycardic and tachypneic. Exam reveals dry oral mucosa and suprapubic tenderness. POC glucose is 422 mg/dL. What is the diagnosis, and what are your next steps?
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Diabetic Ketoacidosis: “Sneaky” triggers and clinical pearls
DKA is a life-threatening condition, with many different “sneaky” triggers. What do you need to consider in the evaluation and treatment of DKA and its many triggers?
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R.E.B.E.L. EM – Mythbuster: Glucose Levels Must be Below a “Safe” Threshold Before Discharge
Anyone who works in the Emergency Department has seen patients brought in by EMS or sent from the clinic with a chief complaint of “high blood sugar.” Now, we are not talking about patients with diabetic ketoacidosis, but just simple hyperglycemia. This is a common complaint with no real consensus on optimal blood glucose levels before safe discharge.
A Well-Grounded Myth? The Association of IV Fluids with Cerebral Edema in Pediatric DKA
IV fluids are classically associated with increased risk of cerebral edema in pediatric DKA. What is the literature behind this association? What mechanisms account for cerebral edema, and what should the emergency physician do?
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PEM Playbook – Vomiting in the Young Child: Nothing or Nightmare
In the young child, vomiting is the great imitator: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral. To help us organize, below is a review of can’t-miss diagnoses by age.
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Cerebral Edema and Diabetic Ketoacidosis
Cerebral edema is the most feared emergent complication of pediatric diabetic ketoacidosis. Fortunately, it is relatively rare, but the rarity can lead to some confusion when it comes to its management.
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Myths in DKA Management
Anand Swaminathan, MD MPH (@EMSwami) addresses urban legends in DKA management, including VBGs vs ABGs, when to replete potassium, bicarb administration, and insulin boluses.“The bolus insulin group had longer lengths of stay and a 6-fold increase in hypoglycemic episodes”
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