Why Is Dka An Emergency

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Ebm Diabetic Ketoacidosis

Epidemiology New diagnosis of diabetes 10-27%. Infection ~ 35%, inadequate insulin ~ 30%, surgery, trauma, alcohol, cocaine and drugs such as steroids, thiazides, sympathomimetics, pentamidine. No cause in 19-38%, but poor compliance / economic reasons frequent. Mortality 1% in adults, but 5% if over 65 years. Also high 15% in patients with hyperglycaemic, hyperosmolar non-ketotic syndrome (HHNS), when BSL usually > 50 mmol/L, more dehydrated with osmolality is > 320 mosm/L – can calculate latter by (2[NA + K] + glucose). Diagnostic Criteria Raised glucose >11.1 mmol/L Acidosis with arterial / venous pH < 7.3, or venous bicarb < 15 mmol/L Ketonaemia or ketonuria (urinalysis may miss 3-beta hydroxybutyrate early). Management / Complications Hypoperfusion Rapid initial crystalloid, especially for significant circulatory insufficiency, at 15-20 mL/kg in first hour ie. 1-1.5 L. Possible role for bicarbonate is in patients with impending cardiovascular collapse, if pH < 6.9. Dilute 100 mmol 8.4% bicarbonate in 250-1000 mL 0.45% NS, and give over 30-60 minutes with 20 mmol K via infusion pump. (Note there are no prospective data concerning bicarbonate use below pH 6.9, and from 6.9-7.1 Continue reading >>

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Popular Questions

  1. Brian K. Price

    Is there any relation between the emergency number 911 and 9/11 attacks or is it a coincidence?

  2. Fiona Sutherland

    Also, it is only a coincidence in the United States. Most countries use a day/month/year format which means the date of the September 11th attacks are rendered as 11/9. Which is not an emergency number anywhere. [Edit: as others have pointed out in the comments, this is the emergency number of at least Japan and China.] And of course, the emergency numbers are different in most countries from the US (so 911 would only be of interest to American observers.)

  3. Franklin Veaux

    The FCC and AT&T chose 911 as a standard emergency number in 1968, partly because it is easy to remember and partly because it was easy to program the telephone switches of the time to treat that number differently from other phone numbers.

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