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Emergencies and resuscitation

How to recognize diabetic ketoacidosis

Other platforms explain it with text and video. In Making Synapses you practice it on the patient.

MD / DOPANursing (NCLEX)
Practice it in VR with Blocky

DKA is a triad: high glucose, ketones and acidosis. Fluids come first, and potassium must be checked before insulin.

Step by step

  1. Suspect

    Thirst, urination, vomiting, belly pain, fast deep breathing, fruity breath, confusion. [1]

  2. Glucose and ketones

    Glucose usually above 250 mg/dL with ketones. [1]

  3. Acidosis

    pH below 7.3 or bicarbonate below 18. [1]

  4. Fluids

    IV fluids first. [1]

  5. Potassium then insulin

    Check potassium (at least 3.3) before starting an insulin infusion. [1]

  6. Trigger

    Missed insulin, infection, new diabetes, heart attack. [1]

Common errors

Practice it in Making Synapses

In Making Synapses you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.

Making Synapses cases that train this skill

Sources

  1. NCCPA PANCE Content Blueprint
  2. NASEMSO National Model EMS Clinical Guidelines
  3. NREMT psychomotor skill sheets (EMT and Paramedic)

Facts and steps follow NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic). Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.