Case 3 - DKA Flashcards

1
Q

ABG for DKA

A
  • Metabolic acidosis usually with respiratory compensation
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2
Q

Biochemicla markers for DKA

A
  • Metabolic acidosis
  • Hyperglycaemia (more than 11mmol/L0
  • Ketonaemia (more than 3mmol/L)
  • Bicarbonate less than 15mmol/L
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3
Q

Presentation of DKA

A
  • History poor management of diabetes
  • History vomitting
  • Dehydrated appearance
  • High resp rate
  • Tachycardia
  • Hypotensive
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4
Q

Immediaate management DKA

A
  1. Fluids - 0.9% saline 1L over 1hr x2, then 1L over 2hrs x2, then 1L over 4hrs x 2
  2. Fixed rate insulin infusion
  3. Monitor K+ - insulin can cause hypokalaemia - replace if 3.5-5.5, if less may need ITU
  4. Avoid hypoglycaemia - if falls below 14 start 10% dextrose
  5. LMWH
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5
Q

Good DKA summary treatment

A
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6
Q

Further investigations to find cause of DKA

A
  • FBC
  • U&Es
  • LFTs
  • ECG
  • CXR
  • Urine dip
  • VBG
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7
Q

At what stage do you consider putting patient back on regular SC insulin, how would you do it?

A
  • Resolution defined pH more than 7.3 and ketones less than 0.6mmol/L
  • If ketonaemia resolved but not eating/drinking move to variable rate/sliding scale insulin
  • If eating and drinking can commence back onto usual schedule
  • Do not discontinue intravenous
    insulin infusion until 30 minutes after subcutaneous short
    acting insulin has been given
  • Manage by Diabetes specialist team usually, if not follow local guidelines
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8
Q

How to assess patients response to treatment?

A
  • Hourly blood glucose
  • Hourly ketones
  • VBG at 60 mins, at 2hrs then every 2hrs
  • Monitor urine output
  • Assess for fluid overload
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9
Q

Most likely causes of DKA

A
  • Insulin - lack of
  • Infection
  • Infarction
  • Infant - pregnancy
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10
Q

Aims for falling ketones/glucose/bicarb

A
  • Decrease of 0.5mmol/L/hr is aim for ketones
  • Or rise in bicarbonate 3mmol/L/hr
  • Fall glucose 3mmol/L/hr
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11
Q

Preventing DKA

A
  • Check CBG regularly
  • Regular f/u with diabetes specialists
  • Education on complications and seriousness of condition
  • Education on warning signs of DKA
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12
Q
A
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