Diabetic Ketoacidosis Flashcards
(25 cards)
What are the three main characteristics of diabetic ketoacidosis (DKA)?
Hyperglycemia, ketosis, acidosis
Hyperglycemia: blood glucose >11 mmol/L; Ketosis: blood ketones >3 mmol/L or urinary ketones ++ or higher; Acidosis: pH <7.3 or bicarbonate <15 mmol/L.
What population has the highest incidence of DKA?
Young people aged 18-24.
What is the leading cause of death in people under 58 years old with Type 1 Diabetes Mellitus (T1DM)?
Diabetic ketoacidosis (DKA) due to cerebral oedema.
What are the primary ketones produced during ketogenesis?
Acetone, 3-beta-hydroxybutyrate, acetoacetate.
What causes the acidosis seen in DKA?
The production of ketones.
What physiological process contributes to dehydration in DKA?
Osmotic diuresis caused by hyperglycaemia.
What percentage of DKA presentations represent a first presentation of Type 1 Diabetes?
10-20%.
List common triggers for DKA.
- Infections
- Dehydration and fasting
- Missing doses of insulin
- Medications (e.g., steroid treatment or diuretics)
- Surgery
- Stroke or myocardial infarction
- Alcohol excess or illicit drug use
- Pancreatitis.
What is the initial management step after starting IV fluids in DKA?
Set up a fixed rate insulin infusion.
What is the composition of the insulin infusion for DKA management?
50 units of Actrapid in 50ml of 0.9% NaCl.
What is the rate of the insulin infusion for DKA?
0.1 units/kg/hour.
What should be continued if the patient is already on long-acting insulin?
Continue long-acting insulin.
What is the target for ketone reduction in DKA treatment?
Ketones should fall by > 0.5mmol/L/hour.
What should blood glucose fall by during DKA treatment?
3 mmol/L/hour.
What should be started once blood glucose is below 14 in DKA management?
A 10% glucose infusion.
How is DKA considered resolved?
When ketones are less than 0.6 mmol/L and pH is over 7.3.
What should be done once DKA is resolved and the patient can eat and drink?
Start a subcutaneous regimen of insulin.
When should the insulin infusion be stopped after starting subcutaneous insulin?
Half an hour after the first dose of subcutaneous short acting insulin.
True or False: Patients with DKA are at high risk of developing clots.
True.
What type of prophylaxis should be prescribed to DKA patients?
VTE prophylaxis with low molecular weight heparin.
What regular monitoring is required during DKA treatment?
Regular venous blood gases to monitor potassium, bicarbonate, and pH.
What is diabetic ketosis?
Hyperglycaemia and raised ketones in the absence of acidosis is known as diabetic ketosis
What is the treatment of diabetic ketosis?
subcutaneous insulin, fluids (IV or oral depending on clinical picture) and careful ongoing monitoring of blood glucose and ketones
Which part of the brain is affected in diabetic ketoacidosis?
Swelling of brain parenchyma causes cerebral oedema, with headache, bradycardia and deterioration in neurological status
