Flashcards in 2-5-16-DM1 Case (Kirila) Deck (14):
Skin tenting (turgor) is a sign of ___
Describe Kussmaul breathing:
-Metabolic acidosis (DM)
List signs for DKA:
-Acetone (fruity) breath odor
-Dry mucous membranes
-Poor skin turgor
Plasma potassium is expected to ___ during DKA
Increase--> since acidosis causes K+ to shift out of cells
What is expected of the anion gap during DKA?
Increased (should be between 5-16 mEq/L)
What set of values from a CMP are used to calculate the anion gap?
Na, Cl, and CO2 (or HCO3)
What does MUDPILES stand for in High Anion Gap Acidosis?
Isopropyl alcohol, Iron, Isoniazid
When do you want to consider K+ replacement in DKA?
When serum [K+] is less than 5.5 mEq/L
What are contributing factors to the development of type 1 diabetes?
-Multiple autoimmune mechanisms possible
-Environmental factors (possible triggers), i.e., Cocksacki, enterovirus
What are the most likely predisposing factors for DKA?
-Previously undiagnosed diabetes
What are features shared by both type 1 and type 2 DM?
-Insulin deficiency-either absolute or relative
-Glucagon excess-either absolute or relative
What is the acute treatment for fluid replacement in DKA?
-2-3 liters NS (Normal Saline) (0.9%) over first 1-3 hours (5-10 ml/kg/hr)
-Then, 1/2 strength saline (0.45%) at 150 ml/hr
-When glucose reaches 250 mg/dl, switch to D5 1/2 NS (5% dextrose and 0.45% saline) at 100-200 ml/hr
-Fluid deficit is often 3-5 liters
What is the acute treatment for insulin administration in DKA?
-10-20 units IV or IM (IV if possible)
-then, 5-10 units/hr continuous IV (or 0.05-0.1/kg/hr)
-Increase if no response in 1-2 hours-orders can be written with guidelines to titrate