DKA
cause of death: increased ICP/cerebral edema/herniation
- Theory: idiogenic osmols produced in brain to counteract increasing serum osmols
- Rapidly decreasing glucose causes reversal of fluid shift into brain -> herniation
- Alternate theory: kussmaul breathing causes CO2 decrease -> cerebral vasoconstriction and stoke or reperfusion injury
-initially sodium goes “down”, but corrected for glucose is super high
Resuscitation:
- Fluid bolus 20cc/kg + basal insulin administration
- 2 bag method: LR/NS with insulin and D5 1/2NS with varying amounts of potassium to prevent hypokalemia
- Run at 1.5 maintenance rate until anion gap closes
- Glucose reduce no more than 100 per hour
HHS:
Cause of death: dehydration and multi organ failure (pancreatitis, rhabdo, AKI, rc)