DKA

Question 1

define DKA?

Answer 1

• Diabetic ketoacidosis is a state of high ketones due to uncontrolled lipolysis which results excess free fatty acids and therefore ketone bodies. Accompanied by very high glucose levels

Question 2

who does DKA occur in?

Answer 2

• It is common in T1DM

Question 3

what are the causes of DKA?

Answer 3

o Infection
o Missed insulin doses
o Myocardial infarction

Question 4

what are the presenting symptoms of DKA?

Answer 4

o	Abdominal pain 
o	Vomiting
o	Polyuria, polydipsia and dehydration 
o	Kussmaul respiration 
o	Acetone smelling breath

Question 5

what are the key investigations and results of a DKA?

Answer 5

o glucose > 11 mmol/l or known diabetes mellitus
o ABG: pH < 7.3
o bicarbonate < 15 mmol/l
o ketones > 3 mmol/l or urine ketones ++ on dipstick

Question 6

how is a DKA managed?

Answer 6

o 1. Fluid replacement – normal saline
o 2. Insulin – IV infusion at a fixed rate with long acting insulin (no short acting)
o 3. Correction of electrolyte disturbance – insulin causes potassium to drop

Question 7

when can management of a DKA be stopped?

Answer 7

o PH> 7.3
o Blood ketones <0.6mmol/L
o Bicarbonate >15mmol/L

Question 8

what are the complications of a DKA?

Answer 8

o Gastric stasis
o Thromboembolism
o Arrhythmias secondary due to hyperkalaemia
o Iatrogenic due to incorrect fluid therapy
o Cerebral oedema (in kids especially!) – causes seizures
o ARDS
o AKI