R.E.B.E.L. EM - By Salim Rezaie
"Myth #1: We should get ABGs instead of VBGs in DKA
Myth#1 Busted: VBG can be used in place of ABGs
Myth #2: After Intravenous Fluids (IVF), Insulin is the Next Step
Clinical Bottom Line: After starting IVF, the next step in DKA management is electrolyte replacement, NOT Insulin.
Myth #3: Once pH <7.1, Patients Need Bicarbonate Therapy
Clinical Bottom Line: Intravenous bicarbonate therapy may transiently make acidemia better, but there is no improvement of glycemic control, time on insulin, time to hospital discharge, and in kids can worsen cerebral edema.
Myth #4: We Should Bolus Insulin Before Starting the Infusion
Clinical Bottom Line: Insulin boluses increase hypoglycemic events without other clinical benefits in the treatment of DKA.
Clinical Bottom Line in DKA Management:
- VBG can be used in place of ABGs
- After starting IVF, the next step in DKA management is electrolyte replacement, NOT Insulin.
- Intravenous bicarbonate therapy may transiently make acidemia better, but there is no improvement of glycemic control, time on insulin, time to hospital discharge, and in kids can worsen cerebral edema.
- Insulin boluses increase hypoglycemic events without other clinical benefits in the treatment of DKA."
http://rebelem.com/diabetic-ketoacidosis-dka-myths/