How can diabetic ketoacidosis be defined?
A disordered metabolic state
Usually occurs in absolute or relative insulin deficiency as well as an increase in counter-regulatory "stress" hormones (glucagon, adrenaline, cortisol and growth hormone)
Ketoacidosis occurs as a result of lipolysis whilst stress hormones induce hyperglycaemia
How can DKA be biochemically diagnosed?
- >3mmol/l ketonaemia (>2++ of urine dipstick)
- >11.0 blood glucose
- <15mmol/l bicarbonate (or venous pH <7.3)
DKA is usually caused by which 4 main factors?
- Non-adherence with treatment
- Newly diagnosed diabetes
- Alcohol and illicit drug use
What are the key signs and symptoms of DKA?
- Thirst and polyuria
- Abdominal pain and weakness
- Breathless - Kussmaul's breathing
- Ketones on breath
What are the two main associated conditions with DKA?
- Underlying sepsis
What is the range of blood glucose levels someone with DKA can present at?
10 - 100mmol/l
(usually it is around 40 mmol/l)
Above which level is potassium usually at in DKA presentation?
Why is it a worry if potassium levels are low upon presentation?
This can cause CV issues and death
What is the normal range of blood potassum levels?
Below which blood potassium level is it considered dangerous?
<3.5mmol/l is considered hypokalaemia
2.5 - 3.0mmol/l is moderate hypokalaemia
<2.5mmol/l is severe hypokalaemia and is the most severe
How are the following affected in a typical DKA presentation:
a) Raised (poor kidney function)
c) Raised (contributes mildly to acidosis)
Ketones will be above which level in the blood during DKA?
Which ketone is measured
a) In the blood
b) In the urine?
In most severe cases of DKA, at which level is bicarbonate?
(<15mmol/l is diagnostic)
Amylase is often raised in DKA, what may this indicate?
WCC in severe DKA is at around 25/nL, what may this infer?
- Severity of DKA
What is the normal range of amylase in the blood?
Usually < 100 U/L
This varies drastically
Some ethnicities can have normal amylase levels at 180 U/L
Amylase levels around 900 U/L are almost diagnostic of pancreatitis
Less remarkably raised amylase levels are not so severely raised
What are the biggest risks of death for adults with DKA?
- Aspiration pneumonia (due to acute gastric dilatation)
What is the biggest risk in children with DKA?
How is DKA treated?
- Fluid is given (0.9% NaCl)
Very rarely are phosphates and bicarbonate given as these correct themselves, but it is not wrong to correct them
Normal ketone levels are below which value?
What is HHS?
Hypergylcaemic hyperosmolar syndrome
Which complication has a higher mortality?
DKA or HHS?
Which people are particularly at risk of HHS?
- Older people
- Younger people of non-caucasian background
In a typical case of HHS, the patient either _______ know they have diabetes or they __________ _______ _______
In a typical case of HHS, the patient either doesn't know they have diabetes or they control diet only
How can HHS be brought on?
- High refined sugar intake
- New diagnosis
- Diuretic or steroid use
What are the main associated risks for HHS?
- Cardiovascular event (stroke or MI)
- Medications (glucocorticoids and thiazide diuretics)
Blood glucose levels in HHS are generally _________ than in DKA
Blood glucose levels in HHS are generally higher than in DKA
How is osmolarity calculated?
2 x [Na+K] + urea + glucose
What is the normal range for osmolarity?
285 - 295 mmol/kg