Diabetic ketoacidosis (DKA) is seen so often in our ED we may take the diagnosis and treatment for granted. Just follow the numbers – potassium 3.5, glucose 250, insulin drip at 0.1 U/kg/hr. But it helps to understand the underlying pathophysiology, because this can help you form a more nuanced Read more…
Case: It’s your 5th straight night and your pediatric ED shift ends in one hour. A few stable patients came in during your shift, and you’re happy about that. No one wants kids to be sick. Your mind begins to wander. To be honest, the inner fat kid you’ve always Read more…
Setting the Scene Your patient is a 21 year-old female with a history of type 1 diabetes mellitus who was brought to the ED by her boyfriend for diminished responsiveness. In a stupor, she is unable to give any history. Her vitals are: BP 102/66, pulse 120, respiratory rate 24, Read more…
A young woman’s life was truly saved by the one and only… Dr. Molly Cutright! A 28 year-old woman with no past medical history was brought in by EMS for altered mental status. EMS reported that the patient had “belly pain and was pregnant.” She was moaning and not making Read more…
In 2013, the FDA approved a new class of anti-diabetic medications called sodium-glucose cotransporter-2 (SGLT2) inhibitors. Insulin and metformin remain as preferred first-line agents for type-1 diabetes (T1D) and type-2 diabetes (T2D), respectively.1 However, due to their novel mechanism of action, SGLT2 inhibitors are an attractive second- or third-line option Read more…
Welcome to this month’s edition of Staten Island Corner. The motivation for this comes from a common question that I am sure all of you have had at one point or another. The other day during a shift there was a debate about the accuracy of ruling in or ruling Read more…
Pediatric Conference 4/4/12 Follow Up: DKA Management Clinical Pearls DKA in Pediatrics: DKA occurs when there is a disruption in the balance between insulin and counter-regulatory hormones secondary to a deficiency in circulating insulin. The resulting state is hyperglycemia, hyperosmolarity, increased lipolysis, ketonemia and metabolic acidosis. Diagnostic criteria Read more…