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Landolfiโs sign #Cardiotwitter
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?
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 ๐ฝ๐ฟ๐ฒ๐๐ฒ๐ป๐ฐ๐ฒ/๐ฎ๐ฏ๐๐ฒ๐ป๐ฐ๐ฒ ๐ผ๐ณ ๐ธ๐ฒ๐๐ผ๐ฎ๐ฐ๐ถ๐ฑ๐ผ๐๐ถ๐.
- pH < 7.30
- Bicarbonate < 18 and
- Glucose > 250
The key differentiating feature is the ๐ฝ๐ฟ๐ฒ๐๐ฒ๐ป๐ฐ๐ฒ/๐ฎ๐ฏ๐๐ฒ๐ป๐ฐ๐ฒ ๐ผ๐ณ ๐ธ๐ฒ๐๐ผ๐ฎ๐ฐ๐ถ๐ฑ๐ผ๐๐ถ๐.
3/6 This patient has hyperosmolar hyperglycemia syndrome (HHS) which commonly causes significant mental status changes as seen in the case.
๐ chart from UpToDate ๐
๐ chart from UpToDate ๐
