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Flashcards in DKA Deck (15):
1

plasma glc to diagnose DKA

> 250 mg/dl

2

plasma glc to diagnose hyperglycemic hyperosmolar syndrome

> 600 mg/dl

3

How is mild, moderate, and severe DKA distingushed?

serum pH and bicarb

mild: 7.25-7.3 and **********
moderate: 7-7.4
severe: < 7

4

preipitating factors for DKA and HHS

infection
new onset DM
DC insulin
unknown

5

hormone of "fed state" vs "fasting state"

fed = insulin and fasting = glucagon

6

anything that causes stress produces (insulin or glucagon) secretion

glucagon

7

how does acute insulin deficiency lead to circulatory failure?

↑blood glc → ↑urine glc → polyuria → dehydration and loss of electrolytes → circulatory failure

+ glucagon
→ ↑glycogen breakdown + ↑ gluconeogenesis, further increases blood glc
→ ↑ protein breakdown for gluconeogenesis → further inc blood glc

8

why to pts with acute insulin def have ↑BUN

↓protein synthesis

9

How does ↑ketone body production lead to acidosis

↑plasma ketones causes ↓alkali reserve (i.e. bicarb) → acidosis

10

how is the glucagon:insulin ratio changed in DKA

↑glucagon:↓insulin

11

how does insulin def lead to ↑FA oxidation ∴ ↑KB production

↑protein kinase → activates lipase → ↑TG to FFA

12

TCA cycle is (on or off) in DKA. significance?

OFF → FFA are converted to glc to further ↑hyperglycemia ????

**FFA converted to citrate, ↑↑↑ citrate inhibit TCA, so FFA shunted into glc production???

13

What are the enzymes needed to convert FFA to glc?

Are these active or inactive in DKA?

PC
PEPCK
F 1,6 bisphosphate
G-6-Phosphate

inactive??

14

What inhibits the TCA cycle in DKA?

citrate

15

In DKA anion gap is ↓ or ↑?