- Other complications seen: DKA, hyponatremia (?SIADH)
- They desat rapidly once RSI paralytics are in. There is a 15 sec window to pop a tube in. Use a LMA to bag the patient if required between attempts. Use in-line viral filters.
وفي حالات Electrolyte disturbance , metabolic acidosis sush as DKA , mild hyponatremia
it has a use as a priming solution for various procedures (e.g., hemodialysis procedures) and to initiate and terminate blood transfusions (only fluid used for blood administration) and shock
Actual question from hospital coder regarding my patient with wicked DKA, pH 6.9:
'You didn't document the reason for patient's weakness and fatigue. We noted the patient had hyponatremia, was that the cause?'
Where to start. Omfg. pic.twitter.com/oWJeCujj39
On my shift tonight I took care of patients with
-DKA and pneumonia
-GI bleed and renal failure requiring intubation
-fecal impaction causing urinary retention
And so much more.
Why I love emergency medicine
Ah, wait, I lied. We do get it. It’s been a while since I got consulted for hyponatremia that didn’t have a semi-obvious cause (recent neurosurgery, adrenal insufficiency, DKA, etc), so I didn’t think about it.
That’s it the next time I have to think about DKA I’m using this model
- relative hyponatremia 2/2 hyperglycemia
- ketone production from fat 2/2 lack of insulin
- anion gap metabolic acidosis
- watch for falsely closed gap 2/2 hyperchloremic acidosis
The worst is when they try to get me to code “hyponatremia” for low Na in a patient admitted for DKA with crazy high glucose.
They can correct for glucose too if they really feel like pestering me. The onus is not on me to prove that their request is incorrect. Waste of time.
@NHSLanarkshire thanks to ur a&e/wd7 staff & specialist nurses, bro recv’d treatment he required for DKA, asthma & hyponatremia As @DrGregorSmith says, the NHS remains open for non-Covid issues. Pls use it if required. Without interventions, my bro wldn’t be alive today
Large shifts in sodium (<119 mmol/L) and water balance in the brain arising from systemic medical disorders (e.g. DKA, HHS) and hyponatremia from any cause (e.g. water intoxication, SIADH) can lead to convulsions and coma.
Hyperosmolar coma occurs at >350 mosmol/L.
Mindblown moment when i diagnosed patient with a long list of problems
1) fluid overload 2ry to decompensated CCF
2) Sepsis 2ry to HAP
3) CVA with left sided hemiparesis
4) hypervolemic hyponatremia
5) uncontrolled DM, not in DKA, TRO HHS
Medical tengok, impression
Risk factors: reduced intake as protein energy malnutrition, reduced absorption as malabsorpation syndrome, increased loss as diarrhea, and intracellular redistribution as DKA.