1 rich Libsyn https://www.libsyn.com 90 600 Diabetic ketoacidosis (DKA) is not just “high blood sugar” — it’s a hormonal storm caused by absolute insulin deficiency and a surge of counter-regulatory hormones. The result is a triad of hyperglycaemia, dehydration, and metabolic acidosis. We follow Sophie, a 23-year-old with type 1 diabetes who arrives with vomiting, Kussmaul breathing, glucose 28 mmol/L, ketones 5.6 mmol/L, and pH 7.08. 🔍 What’s Going Wrong? No insulin → cells can’t use glucose → liver produces more. Glucose spills into urine → osmotic diuresis → 6–8L fluid + electrolyte loss. Fat breakdown produces ketones → metabolic acidosis. Potassium appears normal or high, but total body stores are low. 💉 Treatment Logic (Always in This Order): Fluids first – 1L 0.9% NaCl over 30 mins (slower if frail/cardiac issues). Restores perfusion, lowers stress hormones. Potassium next – replace before insulin if K⁺ &amp;lt;3.5 mmol/L; add to fluids if 3.5–5.5. Insulin third – fixed-rate 0.1 units/kg/h to stop ketone production, not to chase glucose. Add 10% dextrose when glucose falls to ~14 mmol/L to safely continue insulin. Treat the trigger – infection, missed insulin, MI, etc. ✅ Key Message DKA isn’t chaotic when understood physiologically. Fluids, potassium, insulin — in that order. You’re not treating the number; you’re fixing the metabolic storm. The Critical Care Practitioner http://criticalcarepractitioner.libsyn.com/website <iframe title="Libsyn Player" style="border: none" src="//html5-player.libsyn.com/embed/episode/id/38768095/height/90/theme/custom/thumbnail/yes/direction/forward/render-playlist/no/custom-color/88AA3C/" height="90" width="600" scrolling="no" allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen></iframe> https://assets.libsyn.com/secure/content/194659425