DKA

Question 1

Biochemical crtieria

Answer 1

> 11 glucose
venous pH < 7.3 OR bicarb >15
Ketonaemia >3

Question 2

Risk factors DKA

Answer 2

<2 years - new diagnosed
Delay diagnosis
Insulin omission
Poor metabolic control
Prev episodes DKA
GE with persistent vomitting
Eating disorder - diabulimia
Challening social and family circumstanced
Adolescents
Pump therapy

Question 3

What type of insulin is given in pump therapy?

Answer 3

Short acting insulin

Question 4

Mild DKA parameters

Answer 4

mild - pH <7.3, <15mmol bicarb

Question 5

Severity of DKA?

Answer 5

mild - pH <7.3, <15mmol bicarb

Question 6

Moderate DKA severity

Answer 6

pH<7.2, bicarb >10

Question 7

Severe DKA severiy

Answer 7

pH < 7.1, bicarb >15

Question 8

Counterregulatory hormones to insulni

Answer 8

Glucagon
Cortisol
Growth hormone
Catecholamines

Question 9

Aseess for in DKA

Answer 9

GCS
BP, pulse, CRT
Degree of dehydration
Acidotic respiration
Vomitting
BG, ketones, blood gas, U/E, FBC, cultures
Suspect sepsis if fever or hypothemia, hypotension, refractory acidosis or lactic acidosis

Question 10

What does hypotnesion in DKA signa;?

Answer 10

Cerebral oedema

Question 11

Clinical signs and symptoms DKA

Answer 11

Dehydration
Tachycardia/ypnoea
N+V
Deep, sighing resp
Semll acetone
Abdo pain
Confusion

Question 12

Goals of therapy

Answer 12

Cprrect dehydration
Correct acidosis and reverse ketosis
Slowly correct hyper-osmolay
Restore BG to near normak
Monitor complications of DKA and its treatment
Identify and treat and precipitating event

Question 13

When insert AW in DKA

Answer 13

When child camatose

Question 14

When insert NG tube

Question 15

Why monitor T waves in DKA?

Answer 15

Hyperkalemia - tall tented

Question 16

What is a late sign of cerebral oedema?

Answer 16

Papilloedema

Question 17

Treatment DKA

Answer 17

10mls/kg blus over 30 mins
Sec 10ml/kg bolus and reassess may need second
Insulin at 0.05 units/kg/hr
Continue basal insulin
Max weight 75kg/98th percentile for age

Question 18

Segar Holliday formula

Answer 18

Child fluid allowance

Question 19

What do with pump therapy in DKA?

Answer 19

STOP - short acting insulinn

Question 20

When consider reducing insulin in KDA?

Answer 20

BG < 14

Question 21

otassium level in forst 24 hours

Answer 21

Over 5.5 - nil
3.5-5.5
Under 3.5 - central line anaaesthetist high concentration

Question 22

Insulin has aldosterone effect

Answer 22

Pushes potassium into cell

Question 23

Treatement expectation of DKA

Answer 23

Reduction of blood ketone concentation at least 0.5mmol/L/hr
Bicarb rise by 3mmol/l/hr
Cap blood glucose falls by 3mmol/L/hr
Na+ corrects by 4-5 mmol/L/he

Question 24

What monitor in DKA

Answer 24

Headahce
Innapropriate slwoing HR
Recurrnec of vomitting
Change in neurological status - restlessness, irritability, increased drwosy, incontinence
Specific neurological signs - cn palsies, abnormal pupillary repsosne

Question 25

If acidosis is not correctin

Answer 25

Insiffucient insulin to switch off ketones inadequate resuscitation Sepsis Hypercholoramic acidosis - drop saline conc Slaicyclate or other perscription or recreational drugs

Question 26

Hypoglycaemia cut off in neonates

Answer 26

2.6

Question 27

If BG <4 what do you use

Answer 27

10% dextrose 2mls/kg bolus Reduce insulin

Question 28

Hypoglycaemia in normal child

Answer 28

3.6

Question 29

What is hypoglycaemia in child with diabetes

Answer 29

4

Question 30

Complications DKA

Answer 30

Cerebral oedema Hypo Hypokalemia Sepsis Myoglobinuria Spiaration oneumonai Thrombosis Pancereatitis

Question 31

Patient risk factors for hypoglycaemia?

Answer 31

Hypoglycaemia unawareness History of previous hypos Defective glucose counterregulation Long duration of diabetes Erratic insulin absorption <5-7 years

Question 32

Behavioural risk factors for hypoglycaemia

Answer 32

Dietary inconsistency Prlonged fasting Missed meal or snack Strenous exercise - also increases sesntiivtity to insulin

Question 33

Medical risk factors for hypoglycaemia

Answer 33

Drug side effects - beta blockers (block signs of hypos) Dosing errors Unpredicatable insulin kinetics Inappropriate insulin distribution

Question 34

Autonomic symtpoms of hypoglycaemia

Answer 34

Hunger Swaeting and clammy hands Anxiety Pallor Nausea Trembling or shaking

Question 35

Neuroglycopenia symptoms of hypoglycaemia

Answer 35

Dizziness/confusion Headache/irritability Blurred/bright vision Slurred speech Sleep/gazed eyes Weakness Lack of concentration Feeling warm or hot Naughty/aggressive behaviour Nightmares/seizures

Question 36

Risk factors at diagnosis or during treatment of DKA for more severe presentation

Answer 36

Greater hypocapnia at presentation Increased urea at presentataion More severe acidosis at presentation A marked early decrease in serum effective osmolality Attenuated rise in serum sodium conc or early fall in glucose-corrected sodium during therapy Greater volumes of fluid in first 4 hours Administration of insulin in first hour of fluid

Question 37

Features of cerebral oedema

Answer 37

Abnormal motor or verbal response to pain Decorticate or decerebrate posture Cranial nerve palsy (III, IV, VI) Abnormal neurogenic resp pattern

Question 38

Abnormal neurogenic respiration in cerebral oedema features

Answer 38

High RR Grunting Cheyne-Stokes breathing Apnoeas

Question 39

Neuroprotective measures

Answer 39

Elevate head 30 degrees Intubation if impending resp failure Maintain BP + tmep CO2 low end of nomrla Consider crainial imaging