1/6 DKA does not occur de novo. It is always, without exception, triggered by an identifiable STRESSOR. The classic equation of insulin deficiency+counter-regulatory hormones is necessary, but not sufficient, without a trigger. The hunt for the stressor is paramount! #MedTwitter
2/6 The take-home message is critical: 👉DKA = Stressor Present. 📷No Stressor = No DKA. Therefore, treating the DKA without hunting for the precipitating cause is a dangerous and incomplete management strategy.
3/6 Real-world case: Known T1DM patient presents with dyspnea, acidotic Kussmaul breathing. ABG done. DKA confirmed. Team confident. But a ROUTINE ECG revealed the truth: an STEMI. The MI was the stressor that precipitated the DKA. It was almost missed.
4/6 Another case: DKA patient on treatment. Next morning, found with unilateral limb weakness. Easy to blame hypokalemia? But hypokalemia causes symmetric weakness. A CT scan revealed the actual stressor: a STROKE. That was the triggering pathology.
5/6 The lesson? DKA can be the presenting symptom of a larger, more dangerous condition. Diagnosing DKA in a diabetic is easy. The real clinical skill is resisting diagnostic momentum and hunting for the trigger.
6/6 Never be satisfied with just 🔺DKA. It's a sign that something else is wrong. Unmasking the stressor is not just part of treatment ... it's essential to prevent complications and saving lives. #MedEd #Clinicalinsights
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