Mike Brown sits down with Dr. Sarah Fabiano and Mike Ellis as they distill pediatric diabetic ketoacidosis into a clear prehospital approach. Using a “sour blood stew” recipe metaphor, they explain how zero units of insulin produces ketones, osmotic diuresis, dehydration, and electrolyte shifts.

Key takeaways for EMS: prioritize perfusion with IV fluids (lactated Ringer’s preferred), monitor rhythm, obtain potassium before giving insulin, use a two bag insulin/dextrose strategy to close the anion gap safely, and avoid intubation unless absolutely necessary as spontaneous ventilation supports the physiologic need for higher alveolar tidal volumes.

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