 This is Dr. Cray and today we are going to focus on the second part of our diabetes Melitis discussion. We'll be discussing the management of diabetic ketoacidosis So let's get started Okay, so this is the management of diabetic ketoacidosis diabetic ketoacidosis or DKA we said is Is an acute complication of diabetes? Melitis it most commonly occurs in type 1 Diabetics, but there is a subpopulation of type 2 Diabetics that we call ketosis prone type 2 diabetes That DKA can also occur in This subpopulation of type 2 diabetics are usually black men with obesity and Nuonset diabetes DKA is in fact a medical emergency So that means the first priority is going to be your ABCs the person Presents to the emergency room and you will start out your management with an initial Evaluation or work up that includes a thorough, but rapid history and physical examination Your labs are going to include Your ABG a CBC with a differential your urinalysis Glucose be you in creatinine and lights or a chem seven 12 lead EKG chest x-ray culture and sensitivities as needed and In doing this initial Evaluation you're doing a couple of things You will be able to make the diagnosis of DKA as well as Assess the precipitating cause so Typically or the classic presentation Will be a child or an adolescent or as we mentioned That's a population of type 2 diabetics that will present with several days of Polyuria Edypcia abdominal pain nausea and vomiting on their physical examination They will be hypotensive tachycardic cool small respirations and They may have if the precipitating factor happens to be infection of fever but There are specific diagnostic criteria for you to make or confirm the diagnosis of DKA so the confirmation of DKA is A laboratory confirmation those criteria include a blood glucose of greater than 250 milligrams per deciliter ABG with a pH of less than seven point three Bicarp of less than 15 ketone emia and ketone urea that will prompt you to start IV Normal saline at one liter per hour So we can summarize the diagnosis of DKA as hyperglycemia ketone emia and Acidemia and as I said your Initial evaluation in terms of your history physical examination is going to give you some indications of the precipitating causes that we call the five eyes Infection so you'll see things like a fever and A leukocytosis with a shift to the left in a young individual for example ischemia Whether or not it's myocardial infarction cerebral act vascular accident or stroke 12-litre KG will give you indications of the MI it may be Iatrogenic is this an individual that was on corticosteroids thiazide diuretics can also do it do they have a pneumonia so there you will have your Chess x-ray is useful in that respect and we said you do culture and sensitivity as needed is It's an inter-abdominal process is it pancreatitis is it coley? cystitis it may be a young individual that has type 1 diabetes and their first presentation will be Dka so in that respects insulin deficiency is this an established diabetic that Has stopped for whatever reason taking their insulin so the precipitating cause is Some type of stress in the body Thank you very much for watching the video and if you would like to take advantage of our usmle courses Please use the promo code below