Case 3 - DKA Flashcards
1
Q
ABG for DKA
A
- Metabolic acidosis usually with respiratory compensation
2
Q
Biochemicla markers for DKA
A
- Metabolic acidosis
- Hyperglycaemia (more than 11mmol/L0
- Ketonaemia (more than 3mmol/L)
- Bicarbonate less than 15mmol/L
3
Q
Presentation of DKA
A
- History poor management of diabetes
- History vomitting
- Dehydrated appearance
- High resp rate
- Tachycardia
- Hypotensive
4
Q
Immediaate management DKA
A
- Fluids - 0.9% saline 1L over 1hr x2, then 1L over 2hrs x2, then 1L over 4hrs x 2
- Fixed rate insulin infusion
- Monitor K+ - insulin can cause hypokalaemia - replace if 3.5-5.5, if less may need ITU
- Avoid hypoglycaemia - if falls below 14 start 10% dextrose
- LMWH
5
Q
Good DKA summary treatment
A
6
Q
Further investigations to find cause of DKA
A
- FBC
- U&Es
- LFTs
- ECG
- CXR
- Urine dip
- VBG
7
Q
At what stage do you consider putting patient back on regular SC insulin, how would you do it?
A
- Resolution defined pH more than 7.3 and ketones less than 0.6mmol/L
- If ketonaemia resolved but not eating/drinking move to variable rate/sliding scale insulin
- If eating and drinking can commence back onto usual schedule
- Do not discontinue intravenous
insulin infusion until 30 minutes after subcutaneous short
acting insulin has been given - Manage by Diabetes specialist team usually, if not follow local guidelines
8
Q
How to assess patients response to treatment?
A
- Hourly blood glucose
- Hourly ketones
- VBG at 60 mins, at 2hrs then every 2hrs
- Monitor urine output
- Assess for fluid overload
9
Q
Most likely causes of DKA
A
- Insulin - lack of
- Infection
- Infarction
- Infant - pregnancy
10
Q
Aims for falling ketones/glucose/bicarb
A
- Decrease of 0.5mmol/L/hr is aim for ketones
- Or rise in bicarbonate 3mmol/L/hr
- Fall glucose 3mmol/L/hr
11
Q
Preventing DKA
A
- Check CBG regularly
- Regular f/u with diabetes specialists
- Education on complications and seriousness of condition
- Education on warning signs of DKA
12
Q
A
