DKA Flashcards
What are the triad of clinical signs and symptoms of DKA?
Hyperglycaemia >11mmol/L
Acidosis pH<7.3 or Bicarb <15
Ketones >3mmol/L in serum or 2+ in urine
Give 4 potential causes of DKA
- Infection, sepsis should always be excluded
- Underlying acute condition eg MI
- Stress eg surgery, menstruation, trauma
- Poor compliance with medications
What is the pathophysiology of DKA?
A life threatening condition due to lack of insulin. The body cannot utilise glucose, causing increased fatty acid metabolism, increased glucagon production and causes hyperglycaemia
Name 4 Biochemical features of of DKA (other than hyperglycaemia)
- Elevated Hb
- Hypernatraemia
- AKI
- Low pCO2 with metabolic acidosis and large negative BE
Which investigations need to be ordered for suspicion of DKA?
- FBC - looking for underlying infection
- U+Es to look at potassium and sodium
- Plasma glucose and ketones
- ABG - lactate
- URINE DIP - KETONES
- ECG - exclude arrhythmias
What fluids are given to a patient with DKA?
1000ml NaCl 0.9% over 60 mins for the first hour
1L in 2 hours
1L over 4 hours and then continue as per protocol
How is the hyperglycaemia and fixed in DKA?
Fixed rate insulin injection at 0.1units/kg and titrate to effect
Glucose - when serum glucose falls to <12mmol/L, switch replacement fluid to 5-10% dextrose to avoid rapid overcorrection
Continue long acting insulin if they are on it
What are the treatment targets in DKA management?
Reduce blood glucose by 3-5mmol/L/hr
Reduce Ketones by 0.5mmol/L/hour
Maintain K+ between 4-5.5mmol/L - likely to require IV replacement
What are the 3 main complications of DKA?
- Fluid overload
- Arrhythmia (insulin therapy increases potassium intake - hyperkalaemia)
- VTE - haemoconcentrated blood causes a thrombotic state and immobility adds to this risk
