Diabetic Ketoacidosis Flashcards
When is DKA often presented to hospital?
often as complication of Type 1
or as a first presentation of diabetes
what is ketoacidosis
an alternative metabolic pathway used in starvation
due to acetone production (get peardrop breath)
why can you get ketoacidosis in diabetics?
excesssive glucose but because of lack of insulin –> pushes body into starvation state where ketoacidosis is the only mechanism of energy production
Features of DKA
what does their breath smell like?
how does it affect their breathing?
nausea and vomiting
very drowsy
abdominal pain
polydipsia and polyuria
acetone smelling breath (pear drops)
Kussmaul respiration (deep hyperventilation)
what can cause DKA?
missed insulin doses
MI
Pancreatitis
Infection
what is the criteria for diagnosis of DKA?
- Acidaemia pH <7.3
- Hyperglycaemia >11
- Ketonaemia >3 or more than 2+ on dipstick
Severe DKA
describe the signs where any one of them would make you consider transferring them to ICU and central venous access (+ get senior help)
Ketonaemia >6
GCS <12
pH <7
Sats <92
why do DKA patients get hyponatraemia?
due to osmolar compensation for hyperglycaemia
should normalise with Tx
does ketonuria always equate to DKA?
No as anyone can have ^^ketones - especially if they have had an overnight fast
alcohol can also ^ketones
Who is vulnerable to cerebral oedema following fluid resuscitation in DKA?
children and young adults
what are the complications of DKA?
aspiration pneumonia
hypokalaemia
hypomagnesaemia
Tx for DKA
A Fruity Taste Indicated Ketoacidosis Consequently Leaving Gary Thirsty
when do you add K+
ABC Fluids 0.9% saline Tests Insulin K+ assessment Catheter LMWH Glucose assess - if hypo give 10% glucose Treat underlying cause
don’t add K+ to first bag of fluid - add it to the 2nd
