Listen and Learn

[Verse 1: Recognize it]
Blood sugar climbing, over two-fifty high,
Peeing all day, and my mouth is so dry.
Fruity on my breath, now I'm breathing deep and fast,
That's Kussmaul, baby, blowing off the acid past.
Ketones in my urine, pH under seven-three,
Bicarb under eighteen, gap wide as can be.
Belly pain and vomiting, confused and feeling weak,
Missed my insulin or sick, that's the trigger that you seek.

[Chorus]
You're too sweet for me, too sweet for me,
Sugar so high, now there's acid in my bloodstream.
Fluids first, then the insulin drip,
Watch the K, the sodium, the gap, don't let 'em slip.
Too sweet for me, too sweet for me,
Close that gap and set my body free.

[Verse 2: Fluids and sodium]
Normal saline open, fill the tank back up,
Dehydrated deep, give that volume first, enough.
Sugar pulls the water, makes the sodium look low,
Correct it for the glucose 'fore you say it's so.
Add one-point-six for every hundred over one,
That corrected sodium tells you which bag to run.
Normal or it's high? Switch to half NS,
Still low? Stay on normal saline, keep it at its best.

[Verse 3: Potassium and insulin]
Regular insulin, the only kind that's IV,
But check the K first, 'cause the K is gonna leave.
Insulin pulls potassium right into the cell,
K under three-point-three? Hold the drip, replace it well.
Normal K? Add it to the bag to keep it in line,
Over five-point-three? Recheck it, then you're fine.
Low K means rhythm trouble, keep that monitor on,
Peaked or flat T waves, know that something's wrong.

[Verse 4: Mind the gap]
Sodium minus chloride, minus bicarb too,
That's your anion gap, and it's talking to you.
Normal's eight to twelve, but in DKA it's wide,
Those ketones are the acids that the gap can't hide.
Check it every few hours, trend it down the line,
Sugar can look better while the gap's still not fine.
Don't stop the drip early just 'cause the number's sweet,
Gap closed, bicarb up, now the job's complete.

[Bridge]
Sugar down to two-fifty? Add dextrose to the line,
Keep that insulin running till the gap is looking fine.
It's not the sugar that we're chasing, it's the acid in the blood,
Close the gap, raise the bicarb, that's when you know you're good.
Fingersticks every hour, labs every two to four,
Strict I&O, mental status, watch for something more.

[Verse 5: Safety]
Don't drop it all too fast, keep the change slow and wise,
'Cause swelling in the brain is the danger in disguise.
Headache, getting drowsy, pupils acting strange?
Especially in the kiddos, call it, that's a change.

[Outro]
Gap is closed and eating? Time to make the switch,
Give the subQ shot first, then you stop the drip.
Overlap one to two hours so it doesn't bounce back,
Teach the sick-day rules so we stay on track.
Too sweet for me... not anymore.
Critical care is the best care.

[Hook]
Took too much? Don't panic, reverse it!
Know your antidote, nurse, rehearse it!

[Verse 1]
Opioid overdose, pinpoint eyes, slow breath?
Naloxone, baby, pull 'em back from the edge.
Benzo got 'em sleepy, way too deep to stay?
Flumazenil, but seizures might come into play.
Heparin bleeding? Protamine's the cure,
Warfarin too high? Vitamin K for sure.

[Verse 2]
Tylenol overdose, liver on the line?
Acetylcysteine, smells like eggs but works fine.
Dig toxic, seeing halos yellow-green?
Digoxin immune fab, cleanest fix you've seen.
Beta-blocker overdose, heart rate crawling slow?
Glucagon to the rescue, now you know.

[Verse 3]
Mag too high, reflexes gone, breathing low?
Calcium gluconate, keep it close, you know.
Malignant hyperthermia, fever climbing fast?
Dantrolene the hero, make that crisis pass.
Too much insulin? Dextrose, bring it back,
Iron overdose? Deferoxamine's the track.

[Outro]
Dabigatran? Idarucizumab.
Apixaban or rivaroxaban? Andexanet, that's the job.
Reverse it!

[Verse]
Before I give digoxin, I count for a minute,
Apical pulse, the whole sixty, I'm in it.
Under sixty in an adult? I'm holding that dose,
Call the provider, that's how it goes.

[Chorus]
Apical for sixty, check that K,
Low potassium makes the toxicity stay.
Nausea, vomiting, halos yellow and green,
Slow heart, confusion, worst you've seen.

[Verse 2]
Kids get a different number, heart rates run fast,
Check the parameters before that dose is passed.
Draw a level when you need it, keep it in range,
And toxic? Digoxin immune fab, that's the change.

[Chorus]
Clear before cloudy, roll it, don't shake,
Regular first, NPH second, no mistake.

[Verse 1]
Lispro and aspart, rapid on the scene,
Fifteen minutes in, so the tray's gotta be seen.
Regular's short, about thirty to an hour,
The only one IV when you need the drip power.

[Verse 2]
NPH is cloudy, peaks in four to twelve,
Watch for lows in the afternoon, check yourself.
Glargine and detemir, steady all day,
No peak and no mixing, keep 'em that way.

[Bridge]
Shaky, sweaty, heart racing, feeling weak?
Fifteen grams of fast carbs, then recheck what you seek.
Fifteen minutes later, check that sugar again,
Rule of fifteens, that's your diabetic friend.

[Verse]
Lithium's a salt, so it plays with sodium,
Low salt or dry? The level's climbing, oh, it's trouble then.
Keep the fluids steady, two to three liters a day,
Same salt in your diet, don't let it slip away.

[Chorus]
Salt and water, keep it steady,
Point-six to one-point-two, that's ready.
Over one-point-five? The toxic signs show,
Vomiting, diarrhea, coarse tremor, confusion, slow.

[Verse 2]
No NSAIDs, no diuretics, ACE inhibitors too,
They push that level higher, and that's bad news for you.
Draw the level, check the kidneys and the thyroid too,
Lithium can help, if you know what to do.