DKA Flashcards
What are s/s of DKA?
- altered mental status
- kussmaul respirations (deep/rapid breathing)
- N/V/ abdominal pain
- polyuria
- acetone/sweet breathe
- hyperglycemia
- tachycardia/ soft BP
- increased lactate
What are the causes of DKA?
- not taking/ rationing insulin
- illness
- pregnancy
- hyperthyroidism
- trauma
- stroke
What is the pathophysiology of DKA?
- hyperglycemia due to impaired glucose transport
- cannot use glucose as fuel
- alternative fuel source required for metab
- absolute insulin deficiency
What ketone bodies are produced during DKA?
- acetone
- beta-hydroxybutyrate
What anion gap indicates DKA?
> 10
What is the first line treatment of DKA?
fluids:
bolus- 1000ml/h x 2-4 doses
maintenance: 150-200 ml/h until glucose 200-300
What fluids are preferred for treating DKA?
- PlasmaLyte
- LR
What can be given if anion gap remains wide and blood glucose is controlled <200?
dextrose
What electrolytes need replaced during DKA?
- potassium
- bicarbonate
How much potassium do we give for DKA?
20-30 mEq/L of fluid given
What should be done if K<3.3
hold all insulin therapy –> potassium shift intracellularly –> arrhythmia and respiratory muscle weakness
How much bicarb do we give for DKA?
cotroversial could induce CNS acidosis
What insulin do we use for DKA?
regular/ rapid insulin for IV therapy
What is the goal of insulin therapy for DKA?
lower plasma glucose 50-75 mg/dL/h until <200
How much insulin is given using the bolus strategy?
bolus- 0.1 U/kg IV x1
continuous- 0.1 U/kg IV
check after 1 hour, if BG hasn’t fallen 10% repeat bolus
BG<200- 0.02-0.05 U/kg titrate to BG150-200
