Peds DKA

A new series we are trialing on EM:RAP. Rapid consults from one of EM's thought leaders, Dr. Al Sachetti. Leave us your thoughts. Doses and drugs appear at the end of the video.

Binh H. -

Where can I download this card?

Mel H. -

We will get a copy from Al and post soon

Junior Wesner J. -

Hi guys what if I don't have 3/4 NS, and kpo4 in my hospital how can I go about the management of my dka child?

Alfred S. -

The 3/4 NSS solution is designed for the first 24 hours of care, so you can cheat a little and use 1/2 NSS with Potassium Phosphate. PlasmaLyte is a viable alternative, although it will lack the Phosphate anion. In the ED you can get by without the phosphates short term. It is more expensive than saline solutions.

The best option is to meet with your pharmacy and discuss how best to formulate the Dallas Protocol bags. Here are very inexpensive and the pharmacy should be able to obtain the necessary solutions, Good luck.

Yvette P. -

Fantastic, thank you!

Gonzalo M. -

Hi, Im not really agree with the administration of bicarbonate, there is not support in evidence of his use. In fact I finded this sistematic review that analyse it.

Alfred S. -

Dr. Gonzalo:

The Problem with all the studies looking at negative impact of bicarbonate in DKA is that a lot of them are seeing association and not a cause-and-effect. Sicker patients with a lower pH are the ones receiving the bicarbonate so they are going to do worse. Problem with not giving bicarbonate or acetate or some other anion aside from chloride is that you produce a hyperchloremic state the body has no real mechanisms to deal with. As long as the bicarbonate is given as a infusion not a bolus and the patient is able to breathe quick enough to exhale the carbon dioxide generated from the bicarbonate there is usually no problems associated with this.

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