39. Diabetic ketoacidosis Flashcards Preview

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Flashcards in 39. Diabetic ketoacidosis Deck (35):
1

diabetes ketoacidosis is usually due to

insuline noncompliance or increased insulin requirements from increased stress ( eg infection ) --> epinephrine stimulates glucagon secretion

2

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

3

ketone bodies in diabetes ketoacidosis

1. β- hydroxybutyrate
2. acetoacetate
β- hydroxybutyrate > acetoacetate

4

diabetes ketoacidosis is rare in type 2 diabetes - why

endogenous insulin in type 2 diabetes usually prevents lipolysis

5

diabetes ketoacidosis - sign / symptoms

mnemonic : DKA is Deadl ( and fruity breath odor)
delirium / psychosis
Kussmaul respiration ( rapid deep breathing)
Abdominal pain / nausea / vomitng
Dehydration
AND fruity breath odor

6

Kumauul respiration

rapid deep breathing

7

fruity breath odor in diabetes ketoacidosis is due to

exhaled acetone

8

labs

1. hyperglycemia
2. increase H+
3. decreased HC03- (anion gap metabolic acidosis)
4. increased blood ketones level
5. leukocytosis
6. increased K+ ( but total K is depleted

9

pottasium

hyperkalemia, but depleted intracellular K+ due to trranscellular shift from decreased insulin ( decreased total body K+)

10

complications

1. heart failure
2. cardiac arrhythmias
3. cerbral edema
4. mucormycosis

11

mucormycosis is usually caused by

Rhizopusinfenction

12

treatment

1. IV fluids 2. IV inuslin 3 . K+
4. glucose if necessary to prevent hypoglycemia

13

IV fluids why

to prevent dehydreation from polyuria

14

tyoe 1 vs type 2 DM - ages

1: under 30
2Q over 40
exceptions commonly occurs

15

may be seen years ago before clinical disease ( diabetes type 1) develops

autoanibodies against insulin

16

DM1 - antibodies

glutamic acid decarboxylase antibodies

17

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

18

Hyperosmolar hyperglycemia nonketonic syndrome - mechanism

hyperglycemia --> excessive osmotic diuresis --> dehydration --> eventual onset of HHNS

19

Hyperosmolar hyperglycemia nonketonic syndrome -symptoms

thirst , polyuria, lethargy, focal neurological deficits ( seizures) --> can progress to com and death if left untreated

20

Hyperosmolar hyperglycemia nonketonic syndrome -labs

hyperglycemia ( often more than 600), serum osm more than 320 , no acidosis ( ph more than7.3)

21

glucose levels in Hyperosmolar hyperglycemia nonketonic syndrome

often more than 600

22

serum osm in Hyperosmolar hyperglycemia nonketonic syndrome

more than 320

23

ph in Hyperosmolar hyperglycemia nonketonic syndrome

no acidosis ( ph more than7.3)
ketone production is inhibited by the presence of insulin

24

Hyperosmolar hyperglycemia nonketonic syndrome - treatment

aggressive IV fluids
insulin therapy

25

• 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

26

• 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)

27

• 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

28

• 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

29

• 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

30

• 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

31

• What is a common neurologic complication of diabetic ketoacidosis?

Cerebral edema

32

• What are two common cardiovascular complications of diabetic ketoacidosis?

Arrhythmias and heart failure

33

• 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

34

• 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)

35

• A girl has abdominal pain, hyperglycemia, anion gap metabolic acidosis, and ketonuria. Why is her state more common in type I diabetes?

Lipolysis is usually prevented by the presence of endogenous insulin in type 2 diabetes