DKA

Question 1

Complications of DKA related to acute disease (4)

Answer 1

1. Loss of airway
2. Sepsis
3. Myocardial infarction
4. Hypovolemic shock

Question 2

Complications of DKA related to therapy (5)

Answer 2

1. Hypokalemia
2. Hypophosphatemia
3. ARDS
4. Cerebral edema
5. Hypoglycemia

Question 3

Later complications of DKA (4)

Answer 3

1. Recurrent anion gap metabolic acidosis
2. Non-Anion gap metabolic acidosis
3. Vascular thrombosis
4. Mucormycosis

Question 4

Best practice to prevent cerebral edema in DKA treatment (5)

Answer 4

1. Slow reduction of osmolality during treatment
2. Avoid large volumes of hypotonic fluid
3. Drop blood glucose slowly during treatment
4. Do not allow plasma Na to fall during treatment
5. Avoid hypoxia, hypoK, PO4, Mg

Question 5

Goal for glucose decrease in DKA

Answer 5

50-75mg/dl/hr

Add dextrose when glucose <250mg/dl

Question 6

Essential before initiating K therapy

Answer 6

Initial potassium

Adequate urine output

check elecs q2; sugar q1

Question 7

Requires ICU admission

Answer 7

AG >25
Glucose >800
with significant comorbidity

AG< 25, Gluvose <800 or <600 may be admitted on floors or diabetic unit

Question 8

What do you do when glucose does not decrease by 10% after one hour of insulin therapy?

Answer 8

0.14U/kg bolus then resume rate

Question 9

Active goals in DKA (5)

Answer 9

1. Adequate fluid infusion
2. Insulin infusion
3. Maintain K 3.3-5.2
4. Lower glucose by 75mg/dl/hr
5. Maintain adequate electrolytes (Ca, Mg, Phos)

When glucose approaches 200mg/dl, shift IV to D51/2NS with 20-40meq KCL/L; decrese insulin rate to 0.02 to 0.05u/kg/hr

Question 10

Cellular starvation brought about by insulin deficiency and catabolic hormone excess

Answer 10

DKA

Counterregulatory hormones: glucagon (primary), catecholamines, cortisol, growth hormone

Question 11

Primary ketone bodies

Answer 11

B-hydroxybutyrate
Acetoacetic acid

AcAc + NADH <–> BHB + NAD

Question 12

Clinical features in DKA are directly related to? (3)

Answer 12

1. Hyperglycemia
2. Volume depletion
3. Acidosis

Question 13

Altered mental status in DKA better correlates with?

Answer 13

Elevated serum osmolality >320mosm/L or >320mmol/kg

better correlation vs acidosis

Question 14

Parameters to diagnose DKA

Answer 14

1. Blood glucose >250mg/dl
2. AG >10-12
3. HCO3 <15mEq/L
4. pH <7.3
5. Ketonemia or ketonuria

Question 15

Mild DKA

Answer 15

pH: 7.25-7.30
HCO3: 15-18
AG: >10

Question 16

Moderate DKA

Answer 16

pH: 7.0-7.24
HCO3: 10-15
AG: >12

Question 17

Severe DKA

Answer 17

pH: <7.0
HCO3: <10
AG: >12
(+) stuporous

Question 18

Euglycemic DKA

Answer 18

BG <250mg/dl
Serum BHB >3mEq/L

Pregnant, T1DM, Vomiting, Alcohol abuse, LIver failure, Starvation, Arrived after receiving insulin, impaired glulconeognesis, depression, SGLT 2 inhibitors

Question 19

At risk for developing type B (aerobic) lactic acidosis

Answer 19

metformin intake + new-onset renal insufficiency

Question 20

What drugs can cause false (+) urine ketones

detected by nitroprusside

Answer 20

Sulfa drugs
ACEi (captopril)

Nitroprusside reagent detects AcAc
during treatment BHB is converted back to AcAC thus increasing K detected in urine

Question 21

Venous pH is lower than arterial pH by how much?

Answer 21

0.03

Question 22

Potassium is usually depleted by renal losses. However, measured potassium is usually _____ or _____ due to?

Answer 22

normal or elevated

due to:
1. extracellular shift sec to acidemia
2. Increased intravascular osmolarity secondary to hyperglycemia

Question 23

Decrease in serum potassium during therapy is reported to be?

Answer 23

1.5mEq/L or 1.5mmol/L

Question 24

For every 100mg/dl of glucose above 100mg/dl, ___ is added to serum Na

what is the factor if glucose is above 400mg/dl?

Hyperglycemia tends to artificially lower serum sodium levels

Answer 24

1.6 mEqs

2.4 mEqs

Question 25

Creatinine elevation is due to

Answer 25

Pre renal azotemia
Factitious elevation by interaction with nitroprusside assay