diabetic ketoacidosis

Question 1

what values define a diabetic ketoacidosis 3

Answer 1

hyperglycaemial acidosis , ketonuria

glucose >11 or known diabetic

SERUM ketones >3mmol/l

pH <7.3 or HCO3 <15

Question 2

who can present with diabetic ketoacidosis

Answer 2

any diabetic patient that is unwell
-normally T1DM

*-can be first presentation of T1DM

Question 3

how long does a DKA take to develop

Answer 3

usually over 24hrs

Question 4

symptoms of diabetic ketoacidosis 5

Answer 4

abdo pain

vomiting

fatiuge

dehydration

polyuria

Question 5

precipitatoins of diabetic ketoacidosis 4

Answer 5

4 ‘i’s

infection

infarction-silent MIs, common in diabetic patients

incurrent illness-trauma, recent surg, PE

insufficient insulin-poor compliance

Question 6

common precipitant of DKA in young patients 1

Answer 6

vomiting due to alochol excess

Question 7

clinical signs of DKA 4

Answer 7

generally look unwell

dehydrated

pear drop breath

kussmaul breathing

Question 8

give examples of signs of dehydration in a patinet 5

Answer 8

dry mucous membranes

sunken eyes

slow CRT

tachycardia

hypotensive

Question 9

management of DKA in 0-60 mins 2

Answer 9

1l NaCl 0.9% over 1 hr
IV solubule insulin 6U/hour

children 10ml/kg

Question 10

interventions to consider in a DKA presentation 8

Answer 10

ECG
GC
iinsert catheter if oliguric
MSSU
blood culures
central line
CXR
DVT prophylaxis

Question 11

management of DKA 60-120 minutes 2

Answer 11

1l NaCL 0.9% over 1hr
continue insulin 6u/hr

Question 12

management of DKA hours 3 and 4

Answer 12

500ml NaCL 0.9% per hour

Question 13

how should potassium be introduced in DKA managmenet 1

Answer 13

after first hour or when serum K+ is back
-prescribe KCL in 500ml NaCL bag as

Question 14

how much potassium should be given dependent on the serum postassium level (3 options)

Answer 14

if anuric or K+>5mmol/l - none

if K+ 3.5-5mmol/l- 10mmol/l

if K+ <3.5mmol/l - 20mmol/l -NEED CARDIAC MONITORING

Question 15

how often should finger prick glucose and lab glucose be checked in DKA

Answer 15

finger - every hour for first 4 hrs

lab -2hrs and 4hrs

Question 16

when should dextrose be added to DKA management and how much

Answer 16

if blood glucose falls to <14mmol/l in first 6 hours
commence dextrose 10% 500mls 100ml/hr
*CONTINUE 0.9%NACL at 400ml/hr (potassium goes in with this)

IF BM <14 OCCURS AFTER 6HRS:
-change fluid to 0.45%NaCl/5% Dextrose(paeds)

Question 17

when should insulin be reduced

Answer 17

after first 4 hours when blood glucose falls below <14mmol/l

-ONLY AFTER FIRST 4 HOURS

Question 18

what is the target glucose range in DKA managemnt

Answer 18

between 9-14mmol/l

adjust insulin rate as necessary

Question 19

what should be continued whilst on DKA pathway

Answer 19

always continue long acting insulin

Question 20

what should be measured 4hrly for DKA management 2

Answer 20

UnEs

HCO3

Question 21

other aspects of DKA management 3

Answer 21

LMWH due to thrombosis risk

catherised for monitoring fluid balance

symptom mangement ie -antiemetics

Question 22

how is plasma osmolaitily calculated
-what value should it be
-what is it useful for

Answer 22

2 (Na +K) + urea and glucose
-should be higher than 290

-can be used to differentiate between HHS and DKA
-HHS osmolaity is usually higher
-ketones also less signficant part of presentation

Question 23

complications of DKA 6

Answer 23

hypo/hyperkalaemia
hypoglycaemia
cerebral oedema (due to fluid shifts)
pulmonary oedema- ARDS
-arrhythmias due to electrolyte distrubances
AKI

Question 24

describe kussmauls breathing

Answer 24

deep laboured breathing

-associated with severe metabolic acidosis

-form of hyperventilation - creates respiratiory comppensation (alkalosis) in severe acidosis

Question 25

triad of HHS

Answer 25

severe hyperglycaemia dehydration and renal failure mild/absent ketonuria

Question 26

sympomts of HHS 5

Answer 26

lethargy decreased appetite confused or drowsy hypotensive tachycardic -insidious onset -not as common as DKA but mortality is higher (50%)

Question 27

how can clinical features of HHS be classififed 4

Answer 27

general neuro haematologyical cardiovascular

Question 28

general syx of HHS 3

Answer 28

fatigue lethargy N+V

Question 29

neuro syx of HHS4

Answer 29

altered level of consciousness headaches papilloedema weakness

Question 30

haematological syx of HHS 1 -what can this result in 3

Answer 30

hyperviscosity -can result in MI, stroke , peropheral arterial thrombosis

Question 31

cardiovascular syx of HHS 3

Answer 31

dehydration hypotension tachycardia

Question 32

diagnosis of HHS 5

Answer 32

hypovolaemia very high BM >30mmol/l serum osmolality >320mOsmol/l bicarb usally >15momol abscence of ketones -ketoacidosis not present

Question 33

mdanagement of HHS 4

Answer 33

IV fluids -slow and steady IV insulin IV potassium -much less pronunced than DKA so less agressive replacement is required anticoag drugs- due to HHS ptx often being hypercoagulable

Question 34

comparing DKA and HHS degree of insulin deficiney

Answer 34

DKA- absolute insulin deficiency HHS- relative insulin deficiency

Question 35

comparing DKA and HHS BMs

Answer 35

DKA- generally lower BMs HHS- BMs often v high

Question 36

comparing DKA and HHS lipolysis and ketogenesis

Answer 36

DKA- yes HHS- often absent

Question 37

comparing DKA and HHS plasma sodium levels

Answer 37

DKA-usualy normal HHS - high

Question 38

comparing DKA and HHS age of patients

Answer 38

DKA- younger HHS- older