Endocrinologist Manages Patient’s DKA But Results in Coma

This case involves a sixteen-year-old male patient who was being treated for diabetic ketoacidosis. He presented to the emergency room with complaints of a sore throat and vomiting. After an initial evaluation, the patient was found to have a blood glucose level of greater than 650. The patient was started on an insulin drip and admitted to the ICU for close observation of his blood glucose, serum electrolytes, and blood gasses. The patient was permitted to have ice chips for complaints of thirst but reportedly drank over 250ml of water against the advice of the physician on his case. Less than two hours after his transfer to the ICU, the patient began to vomit and suffer from aspiration and the floor nurse immediately came to his aid to lift the head of the bed. While the nurse was using suction to clear the residual mucus, the patient became unresponsive and a code was called. CPR was instituted and the patient was placed on a ventilator but his pupils were fixed and dilated after the resuscitation efforts.

Question(s) For Expert Witness

1. What is the standard of care in acutely treating a patient with diabetic ketoacidosis?

Expert Witness Response E-000964

Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours is always the best approach to care. When treating patients with DKA, the following points must be considered and closely monitored: correction of fluid loss with intravenous fluids, correction of hyperglycemia with insulin, correction of electrolyte disturbances, and the correction of acid-base balance. It is essential to maintain extreme vigilance for any concomitant process, such as infection, cerebrovascular accident, myocardial infarction, sepsis, or deep venous thrombosis.