R.E.B.E.L.EM - November 02, 2015 - By Salim Rezaie
"Recently, I was asked to give a lecture to both my residents and nurses at the University of Texas Health Science Center at San Antonio (UTHSCSA) on some common DKA myths. Now this topic was originally covered by my good friend Anand Swaminathan on multiple platforms and I did ask his permission to create this blogpost with the idea of improving patient care and wanted to express full disclosure of that fact.
I specifically covered four common myths that I still see people doing in regards to DKA management:
- Myth#1: We should get ABGs instead of VBGs
- 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."