DKA

Question 1

Causes of DKA

Answer 1

Infection, trauma, myocardial infarction or surgery
• Drugs (i.e. cocaine)
• Inadequate insulin administration
• Eating disorder
• Pregnancy may precipitate DKA
• Psych disorders
• Severe illness

Question 2

What is happening in DKA

Answer 2

A relative or absolute decrease in insulin or insulin to glucagon ration

Question 3

DKA s/s

Answer 3

Tachycardia
• Severe dehydration
• Abdominal pain
• Can resemble acute pancreatitis or ruptured viscus
• Lethargy & coma
• Rule out other etiology
• Nausea & vomiting
• Hypotension
• Volume depletion & peripheral vasodilatation
• Kussmaul’s respirations
• Metabolic acidosis
• Fruity breath odor
• Increased acetone

Question 4

What level of hyperglycemia is typically found in DKA

Answer 4

300-900

Question 5

What is the serum bicarb level in ketosis

Answer 5

<15

Question 6

What can happen to the pH in DKA

Answer 6

Acidosis

Question 7

What is the beta hydroxybuterate level and what is the level in DKA?

Answer 7

It is a ketone body
>8 in DKA

Question 8

What happens to potassium, phosphate, and sodium levels in DKA

Answer 8

Hyperkalemia
Hyperphosphatemia
Hyponatremia

Question 9

What type of labs should be drawn and how frequently in DKA

Answer 9

CMP q2-3 hours
Blood glucose q1 hour

Question 10

Describe the IV fluid resuscitation used in DKA

Answer 10

NSS 2l @ 200-300mls/hr
Switch to D5 1/2 normal when bg reaches <250 to avoid hypoglycemia and cerebral edema

Question 11

What insulin IV rates should be utilized in DKA

Answer 11

0.1unit/kg IV bolus
0.1 unit/kg/hr IV

Question 12

How to determine patient insulin requirements to transition off of IV

Answer 12

Dose based on previous 8 hours
1/2 long acting and 1/2 short acting