EMS Care EMT Chapter: 24-MCIT-F3-2120 | Diabetic And Endocrine Emergencies starts with an introduction to the topic. Endocrine emergencies including diabetic related crisis, is a critical component of the Pre-Hospital Care. This chapter is designed to equip EMTs with the knowledge and tools to effectively identify, asses, and treat diabetic emergencies. It discusses how to interpret key signs and symptoms, underlying physiology and appropriate interventions.

• Lesson 1: An Introduction To Diabetes And Glucose Regulation
• Lesson 2: Hyperglycemia and Diabetic Ketoacidosis
• Lesson 3: Hypoglycemia
• Lesson 4: Patient Assessment And Treatment Of Diabetic Emergencies
• Lesson 5: Putting it all together: Assessment, Treatment and Transport
• Lesson 6: Special Considerations In Diabetic Emergencies

Excerpt from EMS Care EMT Chapter: 24-MCIT-F3-2120 | Diabetic And Endocrine Emergencies

Recognizing DKA in the field requires a sharp eye. Patients will show signs of severe high blood sugar, which was discussed earlier. One key thing to watch for is Kussmaul respirations –deep, rapid breaths as the body tries to blow off excess acid. You might also notice signs of dehydration, like dry mouth and poor skin elasticity. Abdominal pain is common and can be severe enough to mimic other abdominal emergencies. A classic telltale sign is a fruity odor to the breath. This odor is caused by acetone buildup, a common sign of DKA. This sign may not always present, so do not base your diagnosis on just this. Mental status can range from slight confusion to coma in severe cases. Blood sugar is typically high, above 250 milligrams per deciliter, but remember – it’s the combination of high glucose and ketones that defines DKA.

Patients may present with DKA without knowing that they have diabetes, especially in children.

When assessing these patients, it’s important to look at the whole picture, not just one symptom or number. 

Patients with DKA rarely are deeply comatose.  When treating an unresponsive patient and finding they have an elevated BGL level, be sure not to get tunnel vision.  Continue to do a full assessment and attempt to rule out other possible causes for the patient’s condition, such as head injury, stroke, or drug overdose.