Tuesday, November 7, 2017

Diabetic Ketoacidosis

emDocs - November 6, 2017 - Authors: Reynolds C and Fairbrother H
Edited by: Koyfman A and Long B
"Key Points
  • Always rule out serious life-threatening conditions that may have precipitated a patient’s DKA. DKA is never simple, and the EM physician’s job is not over with the diagnosis and initiation of the insulin drip.
  • Consider DKA in populations with diabetes risk factors, even in patients with no known history of diabetes; particularly in patients suffering CVAs, pregnant patients, patients on high risk medications (olanzapine, risperidone or clozapine) or substance use disorders.
  • Make sure to consider DKA on the differential even in euglycemic patients, particularly those on the novel SGLT2 inhibitors.
  • Persistent tachycardia in DKA in aseptic patients after adequate volume resuscitation may be due to hyperthyroidism.
  • Make sure to consider possible underlying infections or ischemia in DKA patients who present with diffuse abdominal pain as attributing this pain solely to DKA may mask the underlying pathology.
  • Consider cardiac ischemia as MI can be a trigger of DKA, but DKA can also act as a cardiac stress test.
  • Consider DKA in the setting of natural and manmade disasters where the supply of insulin may become unavailable to patients."