Very thorough review of diabetes and DKA from the FDNY OMA.

Download here: http://db.tt/oaJ3TWrc

Also see previous post –  Pediatric DKA  

Some pearls from the lecture Hyperglycemia – Molly Boyd, MD

In DKA the body experiences massive electrolyte derangements, especially with regard to potassium – you may even find peaked T waves evidencing hyperkalemia. This electrolyte shift has occurred over days and the body has been adapting to this state. Correcting this quickly can lead to your patient crashing, especially in pediatrics. Even though your patient is severely dehydrated, rapid fluid boluses can cause quick electrolyte shifts resulting in cerebral edema, seizures and death. For short transports the recommendation is no bolus at all. For longer transports the recommendation is 10ml/kg PER HOUR! (adults are more tolerant but still should only get a 250cc bolus) Additionally, even though your patient is asking, she should not be allowed to drink any water for the same reasons (small quantity of ice chips may be allowed). In the ED they will draw labs and correct the electrolytes over 10 hours or more.

If you patient requires intubation, ensure that you bag them at rate to match their rapid breathing in order to blow off Co2, if you bag them at 12 the will become more acidotic and decompensate faster.

This all goes back to “if it came on quickly, fix it quickly, if it came on slowly fix it slowly”

Many times throughout the Paramedic Program I have come across a drug that has an unexpected use listed in the profile. Not very often are we given a comprehensive explanation as to why this drug works for this other use and it is left to us to try and figure this out. One example that I have seen recently is the use of Glucagon for beta blocker overdose. Glucagon is a hormone used in diabetic emergencies; its use for beta blocker overdose is actually pretty simple once it is explained.