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em@3am

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?

R.E.B.E.L. EM

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.

From @EMSwami

Myths in DKA Management

"The bolus insulin group had longer lengths of stay and a 6-fold increase in hypoglycemic episodes"

Anand Swaminathan, MD MPH (@EMSwami) addresses urban legends in DKA management, including VBGs vs ABGs, when to replete potassium, bicarb administration, and insulin boluses.