Metabolic Crisis in the Prehospital and Acute Care Setting: From Street Stabilization to ICU Nutrition
Abstract
Background: Metabolic crises, specifically diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and refeeding syndrome (RFS), represent critical, often interlinked emergencies encountered from the prehospital setting through intensive care. Their management demands a coordinated, multi-professional approach to correct acute life-threatening disturbances while safely instituting metabolic support. Aim: This narrative review synthesizes current evidence on the integrated management of hyperglycemic emergencies and RFS prevention, analyzing the distinct but interdependent roles of emergency medical services (EMS), nursing, pharmacy, and clinical nutrition across the care continuum. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and CINAHL databases (2010-2024). Relevant studies, guidelines, and protocols were reviewed to construct a narrative synthesis of best practices and evolving concepts. Results: Effective management hinges on prehospital recognition with point-of-care testing, protocol-driven fluid/insulin therapy, vigilant ICU monitoring for electrolyte shifts, and a meticulously calculated, gradual nutritional strategy to avert RFS. System-wide standardization and interprofessional communication are critical success factors. Conclusion: Transitioning a patient from street stabilization to ICU recovery requires seamless integration of discrete professional protocols into a unified care pathway to mitigate mortality and morbidity from metabolic crises.
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Authors
Copyright (c) 2024 Ahood Derdah Mater Alshammry, Mustafa Mohammed Abdullah Oraybi, Taib Hadi Taib Oaribi, Ali Mohammed Bin Mohammed Arishi, Hadi Taher Mohammed Arabi, Mohammad Ali Hussien Mohor, Salem Hamed Mohammed Alqarni, Deeb Marzog Ayed Almashali, Mohammed Abdulaziz Albaqshi, Fatimah mahboob Mohammad Mangahi, Nawal Abdullah Dordeha, Fayez Homod Almodhari Alsahabi, Maryem Saud Khalaf Alrashedi, Naif Majed Sultan Almotairi
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