Discover and read the best of Twitter Threads about #IMpearls

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Signs of aortic regurgitation (Aortic Man) #Bjhm #MedEd #FOAMed #Medtwitter
Landolfiโ€™s sign #Cardiotwitter
Corriganโ€™s pulse @KohanAndres #CardioEd #Medstudenttwitter
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1/6 #IMpearls
56yoF with obesity and T2DM presents to the ED with lethargy and AMS. ROS + for weight loss and polydipsia
Labs: Na 128, glucose 720, serum osm 322
U/A: 3+ glucose and mild ketonuria
ABG: pH 7.32, bicarb 23. VS stable.

What is the dx and best initial treatment?
2/6 Mild ketonuria does not necessarily mean DKA! According to the @AmDiabetesAssn the diagnostic criteria for DKA includes:
- pH < 7.30
- Bicarbonate < 18 and
- Glucose > 250
The key differentiating feature is the ๐—ฝ๐—ฟ๐—ฒ๐˜€๐—ฒ๐—ป๐—ฐ๐—ฒ/๐—ฎ๐—ฏ๐˜€๐—ฒ๐—ป๐—ฐ๐—ฒ ๐—ผ๐—ณ ๐—ธ๐—ฒ๐˜๐—ผ๐—ฎ๐—ฐ๐—ถ๐—ฑ๐—ผ๐˜€๐—ถ๐˜€.
3/6 This patient has hyperosmolar hyperglycemia syndrome (HHS) which commonly causes significant mental status changes as seen in the case.
๐Ÿ‘‡ chart from UpToDate ๐Ÿ‘‡ Image
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