D and V Scenario

From the information gathered so far, what differential diagnosis would best fit this picture and raise your concerns?

You are concerned about DKA due to the patient’s history leading up to his current condition. He is pale, slightly clammy, and his breathing is deep and laboured. What is causing the Kussmaul-sounding pattern of breathing, if this is DKA?

You collect the patient’s observations as: HR 112, BP 95/54, SpO₂ 98%, RR 24, Temp 37.1, BM 29.9, V on AVPU. What is the patient’s NEWS score?

Your concerns are rising quickly as the patient has a NEWS score of 9. You find out the patient has their own ketone meter, so you put it to use. What starting ketone levels are associated with high-risk DKA?

You use the patient’s ketone meter and gain a reading of 4.1 mmol/L, meaning they are at high risk of DKA. How are you going to continue to manage this patient going forward?

You look to gain quick IV access while your colleague works out an extrication plan. Unfortunately, the patient is in their upstairs bedroom. What would you deem to be the most appropriate way to get the patient to the ambulance when navigating stairs, considering patient safety and urgency?

Your colleague states you should consider walking the patient down the stairs for speed and ease. A patient in this situation, who has been in bed all day and considering the current observations, what could you be at risk of causing if continuing with this plan?

You discuss with your colleague and they get the carry chair. As you stand the patient up, they go very pale and dizzy, but recover quickly after you lie them back down. The postural hypotension is likely caused by dehydration and volume depletion. What factors may contribute to dehydration during DKA?

Osmotic diuresis involves the excretion of excess fluid by the kidneys due to high blood glucose levels. What else could this cause that may influence your management of the patient?

Electrolyte disturbances can occur in DKA patients. Which electrolyte are we most concerned about assessing on a 12-lead ECG?

JRCALC states that treatment, including fluid replacement therapy, should not delay transport to hospital. In scenarios like this, would it be appropriate to routinely give oral fluids instead?

You avoid giving oral fluids due to the increased risk of aspiration with a low GCS and the potential exacerbation of vomiting. In severe DKA, why may it be inappropriate for pre-hospital clinicians to administer the patient’s own insulin to reduce blood glucose levels?

What is the main pathological difference between DKA and HHS?

When cells cannot use glucose because insulin is not present to assist glucose transport across cell membranes in DKA, what is the name of the breakdown of adipose tissue that leads to the accumulation of ketone bodies?

Severe metabolic acidosis can cause which effects on myocardial function?