DKA Flashcards
Presentation of DKA? (4)
Kussmaul breathing
hyperkalaemia» tall tented t wave
Sweet breath
nausea and vomiting
What is DKA
Complication of T1DM where there is too much keto acids in the blood causing metabolic acidosis
Why does metabolic acidosis from DKA cause hyperkalaemia?
Because every cell needs at least H+ or K+ inside it.
In acidosis, there is lots of H+ in the blood so it’s pumped into the cells through the H+/K+ transporter so lots of K+ is pumped out of the cells into the blood» HYPERKALAEMIA
what will be present to smell on the breath of someone with DKA?
ketones on breath
what would be first line treatment for a DKA and DMT1 in general?
insulin
why would you give potassium in treatment for a DKA?
to prevent rebound hypokalaemia in response to hyperkalemia in DKA
why don’t DMT1 patients get AKI as soon as expected in a DKA?
polyuria is a protective factor for the kidney
why does caution have to be exercised in giving fluids in a DKA?
to avoid cerebral overload as brain hydration is maintained»> CEREBRAL OEDEMA
Pathophysiology of DKA
Adipocytes are not receiving enough food because of a lack of glucose in cells» lots of glucose in blood but not in cells.
Fats are metabolised by the adipocytes to form fatty acids.
Fatty acids are converted to ketones by the liver through ketosis.
Ketones are converted to keto acids which accumulate in the blood.
Blood acidity increases which causes many symptoms
Mx of DKA?
GRIP
Gastric aspiration
Rehydration» iv fluids
Insulin infusion» move onto subcut insulin when patient is eating properly once emergency is resolved
Potassium replacement in case of hypokalaemia from fluids diluting the k+ in blood
Complications of DKA (4)
Cerebral oedema (because of xs fluid admin)
Hypokalaemia (from Mx of DKA)
Thromboembolism (because of hospital admission and staying in bed for too long)
Hypoglycaemia (because of too much insulin infusion)
Mortality?
5%
