A VBG is adequate for the diagnosis and ongoing management of patients with DKA. ABGs offer no added benefit and are associated with increased pain and complications. Patients with DKA may present with a weak or absent nitroprusside assay reaction on urinalysis for ketones as this test only checks for acetoacetate (the minor ketone body […]
Remember that glucose should be considered the sixth vital sign and any “sick” appearing child should have a point of care glucose done!
HHS is defined by hyperglycemia and hyperosmolarity due to volume depletion with resultant altered mental status Profound hypokalemia is common as a result of osmotic diuresis. Replete aggressively Hypokalemia = hypomagnesemia. Replete both of these electrolytes simultaneously Fluid repletion is the key point in management but careful repletion is vital as patients may not tolerate […]
Guidelines recommend checking an ABG or VBG in all patients with DKA. This practice is not evidence-based and should be abandoned. ABG or VBG provides little information about whether or not the patient has DKA (beyond what is already known from the serum chemistries). Rather than pH, serum bicarbonate may be used to gauge the severity of […]
Myth #1: We should get ABGs instead of VBGs in DKA…Busted: VBG can be used in place of ABGs Myth #2: After Intravenous Fluids (IVF), Insulin is the Next Step…Busted: After starting IVF, the next step in DKA management is electrolyte replacement, NOT Insulin. Myth #3: Once pH <7.1, Patients Need Bicarbonate Therapy…Busted: Intravenous bicarbonate […]
Unless you want to know a patient’s oxygenation (because your pulse oximeter has failed), stop turning your patient into a pin cushion looking for the radial artery and get a venous blood gas
Sodium bicarbonate therapy in DKA (or any other acidosis for that matter) is associated with risks that outweigh NO BENEFITS…DO NO HARM!!! Neither a recent systematic review nor the largest single retrospective cohort of severe DKA support routine use of bicarbonate therapy in DKA Bicarbonate is associated with risk of cerebral oedema and prolonged hospitalisation […]
Myths in DKA Management: The urban legends end here VBG as good as ABG for diagnosis and treatment Aggressively replete potassium prior to starting insulin Bicarbonate is unnecessary in DKA treatment and potentially harmful A bolus of insulin is unnecessary in DKA treatment and potentially harmful