Diabetic Ketoacidosis Flashcards
Identify three clinical features of DKA
- Nausea and vomiting
- Abdominal pain
- Hyperventilation
- Dehydration
- Reduced consciousness
- Acetone smell on breath
- Polyuria
- Polydipsia
- Weight loss
Identify two findings on venous blood gas in DKA?
- Metabolic acidosis with raised anion gap
- Bicarbonate < 15 mmol/l
A blood ketone of what concentration is indicative of DKA
- Greater than 3 mmol/l
What is seen on U&Es in DKA?
- Hypokalaemia
What is seen on urinalysis in DKA?
- Ketonuria (3+)
- Glucose
Identify three differential diagnoses of DKA
- Hyperosmolar hyperglycaemic state
- Lactic acidosis
- Salicylate poisoning
- Uraemic acidosis
Identify three criteria for involving critical care support
- Persistent hypotension (< 90 mmHg)
- Oliguria (< 0.5 ml/kg/hour)
- GCS < 12
- Ketones > 6
- Venous pH < 7
- Potassium < 3.5
- Oxygen < 92%
- Anion gap > 16
What is the initial treatment of DKA if systolic BP is less than 90mmHg?
- 500 ml of saline over 10 to 15 minutes
What is the initial treatment of DKA if systolic BP is greater than 90mmHg?
- 1 litre of saline over 1 hour
When is 10% glucose administered?
- Blood glucose falls below 14 mmol/l
When is 40 mmol/l saline over 1 hour administered?
- Potassium < 5 mmol/l
When is mannitol administerd?
- If cerebral oedema suspected
How is insulin administered in DKA?
- Fixed dose IV insulin neutral
- Dose of 0.1 units/kg/hour
How quickly should blood ketone concentration fall?
- 0.5 mmol/l/hour
How quickly should blood glucose concentration fall?
- 3 mmol/l/hour
