diabetic ketoacidosis Flashcards
1
Q
what can DKA be precipiated by?
A
- new diagnosis of T1DM
- not taking insulin
- intercurrent stress (e.g. pneumonia)
- fasting and not taking enough insulin
2
Q
what are the 4 main causes of ketoacidosis?
A
- fasting
- insulin deficiency
- stress hormones
- dehydration
3
Q
what is the metabolic acidosis caused by? what does it lead to?
A
- metabolic acidosis is caused by reduction in bicarbonate production and inc. H+ buffering
- results in Kussmahl respiration to blow off CO2 to reduce acidosis
- water lost in urine and so is Na+
- this means K+ is lost in urine
- although acidosis shows a high K+, total body K+ is low
4
Q
what are the clinical features of DKA?
A
- polyuria and polydipsia due to diuresis
- dehydration
- hyperventilation
- abdo pain and vomiting
- coma
- gycosuria and ketonuria
5
Q
what investigations should be carried out?
A
- capillary and plasma glucose
- creatinine, K+, Na+
- FBC
- arterial blood gas
- amylase
- ECG, CXR, septic screen
6
Q
what is the treatment?
A
- fluid (normal saline)
- insulin (give dependent on blood glucose levels)
- potassium
- bicarbonate
- cardiac monitor, catheterise, antibiotics, heparin
