The school nurse says it's the stomach flu

[ERDoc]

After 2.2 million dollars in testing the hospital informs your crew that they had been exposed to coxsackie B4.

Please don't take this as a call to withold fluids from DKA pts. Cerebral edema is unheard of in adults. With kids, just stick with your 20cc/kg boluses and you should be fine.

[Dustdevil]

But dammit... I wanna give bicarb!

With normal saline! :twisted:

[Doczilla]

I know we moved on from this, but for educational clarification did you mean she'd need K+ even if she's hyperkalemic? Or did you mean only after receiving bicarb?

ALSO: How does DKA lead to cerebral edema? High sugar in cranial circulation (is that a correct term?) leads to water uptake?to

The exact mechanisms by which people (mostly kids) get cerebral edema in DKA are not exactly known. There is an association with bicarb administration.

Even if the serum potassium is relatively high, the patient will still need potassium supplementation. The serum potassium is elevated because K+ shifts out of the cells in response to the acidosis. The H+/K+ antiporter, a cell surface protein which exchanges hydrogen ions for potassium ions, pulls H+ ions into the cell, giving up potassium into the serum. The kidneys, however, have been trying to shed the excess potassium into the urine, so the total body stores of potassium are low. As soon as the insulin drip starts, the potassium will shift rapidly back into the cells and serum potassium will drop precipitously. Correction of the acidosis with bicarb will do the same thing by reversing the H+/K+ antiporter. Also, once the patient is hydrated by your fluid bolus, the kidneys will start shedding more of the excess serum potassium.

The hyperkalemia and much of the acidosis is more an issue of renal insufficiency brought on by dehydration (if you were perfusing your kidneys adequately, they could deal with much of the excess acid).

'zilla

[chbare]

"If you were perfusing your kidneys adequately, they could deal with much of the excess acid." As I understand, this is part of the reason people tend to improve after only receiving fluids?

Take care,

chbare.

[Adam Swartz]

Bring the IV to the slowest that you can without it clotting off. Call the helo and see how soon it can be to you. Keep trying to bring her sugar down. If the helo is going to take longer than in the squad go code 3. Try to avoid intubating. Give 15 lpm by a non-rebreather. Also keep checking vitals and sugar every five to ten minutes. If possible get a second line for checking sugar. Also the second line might help the hospital should they need to take her straight to surgery. Keep having dispatch try to get ahold of the parents so you can get more medical history. Make sure you have her on your heart monitor, pulse ox, and blood pressure. Keep the IV TKO. Other than that i don't know.

[brentoli]

I say it is MRSA.

[JPINFV]

Bring the IV to the slowest that you can without it clotting off. Call the helo and see how soon it can be to you. Keep trying to bring her sugar down. If the helo is going to take longer than in the squad go code 3. Try to avoid intubating. Give 15 lpm by a non-rebreather. Also keep checking vitals and sugar every five to ten minutes. If possible get a second line for checking sugar. Also the second line might help the hospital should they need to take her straight to surgery. Keep having dispatch try to get ahold of the parents so you can get more medical history. Make sure you have her on your heart monitor, pulse ox, and blood pressure. Keep the IV TKO. Other than that i don't know.

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