Flashcards in 39. Diabetic ketoacidosis Deck (35):
diabetes ketoacidosis is usually due to
insuline noncompliance or increased insulin requirements from increased stress ( eg infection ) --> epinephrine stimulates glucagon secretion
diabetes ketoacidosis - mechanism
stress -- epinephrine stimulates glucagon secretion --> excess fat breakdown and increased ketogenesis from increased free fatty acids which are then made into kentone bodies
ketone bodies in diabetes ketoacidosis
1. β- hydroxybutyrate
β- hydroxybutyrate > acetoacetate
diabetes ketoacidosis is rare in type 2 diabetes - why
endogenous insulin in type 2 diabetes usually prevents lipolysis
diabetes ketoacidosis - sign / symptoms
mnemonic : DKA is Deadl ( and fruity breath odor)
delirium / psychosis
Kussmaul respiration ( rapid deep breathing)
Abdominal pain / nausea / vomitng
AND fruity breath odor
rapid deep breathing
fruity breath odor in diabetes ketoacidosis is due to
2. increase H+
3. decreased HC03- (anion gap metabolic acidosis)
4. increased blood ketones level
6. increased K+ ( but total K is depleted
hyperkalemia, but depleted intracellular K+ due to trranscellular shift from decreased insulin ( decreased total body K+)
1. heart failure
2. cardiac arrhythmias
3. cerbral edema
mucormycosis is usually caused by
1. IV fluids 2. IV inuslin 3 . K+
4. glucose if necessary to prevent hypoglycemia
IV fluids why
to prevent dehydreation from polyuria
tyoe 1 vs type 2 DM - ages
1: under 30
2Q over 40
exceptions commonly occurs
may be seen years ago before clinical disease ( diabetes type 1) develops
autoanibodies against insulin
DM1 - antibodies
glutamic acid decarboxylase antibodies
Hyperosmolar hyperglycemia nonketonic syndrome - definiton / classically seen in
state profound hyperglycemia -induced dehydration and high serum osm, classcially ssen in elderly type 2 diabetics with limited ability to drink
Hyperosmolar hyperglycemia nonketonic syndrome - mechanism
hyperglycemia --> excessive osmotic diuresis --> dehydration --> eventual onset of HHNS
Hyperosmolar hyperglycemia nonketonic syndrome -symptoms
thirst , polyuria, lethargy, focal neurological deficits ( seizures) --> can progress to com and death if left untreated
Hyperosmolar hyperglycemia nonketonic syndrome -labs
hyperglycemia ( often more than 600), serum osm more than 320 , no acidosis ( ph more than7.3)
glucose levels in Hyperosmolar hyperglycemia nonketonic syndrome
often more than 600
serum osm in Hyperosmolar hyperglycemia nonketonic syndrome
more than 320
ph in Hyperosmolar hyperglycemia nonketonic syndrome
no acidosis ( ph more than7.3)
ketone production is inhibited by the presence of insulin
Hyperosmolar hyperglycemia nonketonic syndrome - treatment
aggressive IV fluids
• A diabetic man is in the ED vomiting, delirious, and breathing deeply/rapidly; his breath has a fruity odor. What is the pathophysiology?
Diabetic ketoacidosis; increased insulin requirements (e.g., stressors) cause excess lipolysis/ketogenesis, with resultant ketone bodies
• A diabetic with diabetic ketoacidosis (DKA) has high serum ketone bodies. Which ketone bodies, specifically, is the lab measuring?
β-Hydroxybutyrate and acetoacetate are the two main ketone bodies found in DKA (β-hydroxybutyrate level > acetoacetate level)
• A patient has Kussmaul respirations. Describe the respirations and what state they are common in.
Deep, rapid respirations and air hunger; characteristic of diabetic ketoacidosis
• You suspect diabetic ketoacidosis in an ED patient. What are the glucose, pH, bicarbonate, and WBC levels? What is the acid-base status?
Increased glucose, low pH (increased H+), decreased bicarbonate, increased WBC count (leukocytosis); anion gap metabolic acidosis
• A diabetic with diabetic ketoacidosis has a potassium level of 5.3 mEq/L, but the attending orders intravenous potassium repletion. Why?
Lab value is falsely high (total and intracellular K+ stores are low); acidosis and low insulin levels shift K+ into extracellular space
• A man with a recent episode of diabetic ketoacidosis presents with an infection over his sinuses. What infection are you worried about?
Mucormycosis infection (e.g., Rhizopus fungus), which can be life-threatening
• What is a common neurologic complication of diabetic ketoacidosis?
• What are two common cardiovascular complications of diabetic ketoacidosis?
Arrhythmias and heart failure
• A patient presents with hyperglycemia, abdominal pain, vomiting, and fruity breath. List the core components of your treatment plan.
Intravenous insulin, fluids, and potassium, and, in some cases, glucose to prevent hypoglycemia
• A patient has DKA. When would it make sense to give glucose?
When the glucose level has normalized, but IV insulin is still necessary to aid in potassium correction (to drive K+ back into cells)