Diabetic Ketoacidosis or DKA when seen is the field is often treated as a load and go patient with very little pre hospital treatment being provided. I mean the patient needs insulin and we just don't have that in the ambulance. (Now some agencies may carry it in their drug arsenal, so don't jump on me).

The main thing is that there are some things we can do, to slow the patient from worsening. First though I want to take a look at the general approach for a diabetic emergency.

It is important to check your glucometer each shift and to ensure the strips are properly coded for the machine you are using. Improper use of a glucometer is just like not using it at all. A wrong reading may as well be no reading.

Responding to a diabetic emergency leads us to anticipate the hypoglycemic patient. But while not as common, a DKA patient may be what we find upon arrival.

Taking a look at the signs and symptoms we can also see some similarities in a hypoglycemic patient.

The patient may present with weakness, paralysis, paresthesia, polyuria, nausea, vomiting, thirst, dry mucous membranes, hunger and EKG changes. You should also be aware that acetone odor to breath (fruity smell), hypotension, and coma or stupor may also be present although coma and stupor are usually later signs.

Don't forget that a patient may also have Kussmaul Respirations, which are characterized by respirations that increase in rate and depth. The patient may have all or only some of these signs and symptoms.

Look for high BGL of 300mg/dl or more and unlike hypoglycemic patients, DKA patients are not diaphoretic. Do a complete patient history to determine recent events leading up to the episode and also family history of diabetes for a possible new onset of type I diabetes.

Usually seen in patients with type 1 diabetes. The most common causes are infection, disruption or improper insulin treatment, and new onset of diabetes. It can occur in type 2 diabetic patients as well, but more often when the patient is physiologically stressed such as when they have an infection.

Can DKA be cured in the pre hospital setting like hypoglycemia? No, but we can perform some tasks that will help with the recovery and hopefully slow the patients condition from getting worse.

Keep in mind that DKA patients lose fluids from several sources, this can cause a severe dehydration potential.

Treatment is primarily supportive with the ABC's performed and consideration of advanced airway maintenance such as intubation if the patient is unconscious and unable to maintain an airway. Provide high-flow O2 and monitor pulse oximetry. Initiate an IV of normal saline and start a fluid bolus, using caution if there is pre-existing renal failure.

You should also monitor the EKG for rhythm disturbances.

Remember, don't just load and go with a DKA patient.

Take a careful history, vital signs (including EKG) and monitor the patients’ airway and breathing. Be alert to dehydration and potential hypotension, fluid is your best treatment and contact with your base physician is recommended for further guidelines, the doc may even order Sodium Bicarbonate.

As always, don't forget the basics and try not to get tunnel vision with your diabetic emergency calls. It's not always hypoglycemia, even if it may look that way.

****************************************** Jim Hoffman is a contributor to EMS Solutions. Visit today and claim your free copy of "The ABC's of Diabetes" http://ems-safety.com/free.htm