DKA

Question 1

What is the blood glucose level that indicates hyperglycaemia in DKA?

Answer 1

Blood glucose > 11mmol/L

Question 2

What blood ketone level indicates ketosis in DKA?

Answer 2

Blood ketones > 3mmol/L or urine ketones 2+

Question 3

What bicarbonate level and pH indicate acidosis in DKA?

Answer 3

Bicarbonate < 15mmol/L and/or pH < 7.3

Question 4

What is the primary cause of Diabetic Ketoacidosis (DKA)?

Answer 4

Inadequate insulin leading to hyperglycaemia

Question 5

When does DKA typically occur?

Answer 5

Initial presentation of T1 DM, unwell T2 DM patient, patient not adhering to insulin regime

Question 6

What are the key symptoms of DKA?

Answer 6

• Ketoacidosis
• Dehydration
• Potassium imbalance
• Hyperglycaemia
• Metabolic acidosis (with low bicarb)
• Kussmaul respirations

Question 7

What are some other symptoms of DKA?

Answer 7

• Polyuria
• Polydipsia
• Nausea/Vomiting
• Acetone smell to breathe
• Dehydration
• Weight loss
• Low BP
• Altered consciousness

Question 8

How does ketosis occur in DKA?

Answer 8

No/low insulin leads to liver producing ketones, resulting in high blood glucose and ketones

Question 9

What causes dehydration in DKA?

Answer 9

High blood glucose overwhelms kidneys, causing glucose to leak into urine and osmotic diuresis

Question 10

Why does potassium imbalance occur in DKA?

Answer 10

Before treatmetn: Glucose causes osmotic diuresis causes mass loss of water and electrolytes in urine

On treatment: Insulin drives K+ into cells; without insulin, K+ remains in serum but total body K+ is low

Question 11

What can happen when insulin treatment starts in a DKA patient?

Answer 11

Patient can develop severe hypokalaemia leading to fatal arrhythmia

Question 12

What are the diagnostic criteria for DKA?

Answer 12

All 3: hyperglycaemia (11mmol/L +), ketosis (blood ketone 3mmol/L +), acidosis (pH below 7.3)

Question 13

What should be reversed in DKA treatment before giving insulin?

Answer 13

Dehydration, acidosis, and electrolyte imbalance

Question 14

What should a patient be doing before stopping infusions in DKA treatment?

Answer 14

Eating/drinking, no ketosis/acidosis, and receiving regular SC insulin

Question 15

What are some complications during DKA treatment?

Answer 15

• Hypoglycaemia
• Hypokalaemia
• Cerebral oedema (children)
• Pulmonary oedema (fluid overload/respiratory distress syndrome)

Question 16

Fill in the blank: In DKA, the presence of _______ indicates a state of acidosis.

Answer 16

pH < 7.3

Question 17

True or False: Kussmaul respirations are a symptom of DKA.

Answer 17

True

Question 18

What constitutes severe DKA requiring ITU involvement?

Answer 18

Question 19

What is the fluid replacement requirement for most patients with DKA?

Answer 19

5-8 litres

Patients are typically depleted of fluids in this range.

Question 20

What type of saline is used initially in the management of DKA?

Answer 20

Isotonic saline

This is used even if the patient is severely acidotic.

Question 21

What is the initial rate for intravenous insulin infusion in DKA treatment?

Answer 21

0.1 unit/kg/hour

This is the standard starting rate.

Question 22

When should a 10% dextrose infusion be started in DKA management?

Answer 22

When blood glucose is < 14 mmol/l

It should be infused at 125 mls/hr in addition to the saline regime.

Question 23

What is often the serum potassium level upon admission for DKA patients?

Answer 23

High

Despite total body potassium being low.

Question 24

What may happen to potassium levels during insulin treatment in DKA?

Answer 24

They may fall quickly resulting in hypokalaemia

Potassium may need to be added to replacement fluids.

Question 25

What monitoring is required if potassium infusion exceeds 20 mmol/hour?

Answer 25

Cardiac monitoring ## Footnote This is essential due to potential cardiac complications.

Question 26

What should be continued and stopped regarding insulin in DKA management?

Answer 26

Continue long-acting insulin; stop short-acting insulin ## Footnote This is part of the management protocol.

Question 27

What is the JBDS fluid replacement regime for a patient with a systolic BP on admission of 90mmHg?

Answer 27

1L 0.9% sodium chloride over various time frames ## Footnote Regime includes additional potassium chloride in subsequent infusions.

Question 28

What is the potassium replacement guideline for levels between 3.5-5.5 mmol/L?

Answer 28

40 mmol/L of infusion solution ## Footnote This is the recommended replacement amount.

Question 29

What defines DKA resolution?

Answer 29

pH >7.3, blood ketones < 0.6 mmol/L, bicarbonate > 15.0mmol/L ## Footnote These criteria must be met for resolution.

Question 30

What should occur if DKA criteria are met and the patient is eating and drinking?

Answer 30

Switch to subcutaneous insulin ## Footnote This is part of the transition to outpatient care.

Question 31

What complications may arise from DKA or its treatment?

Answer 31

* Gastric stasis * Thromboembolism * Arrhythmias * Cerebral oedema * Acute respiratory distress syndrome * Acute kidney injury ## Footnote These complications can arise from either the condition or its management.

Question 32

What is a specific risk for children and young adults during DKA treatment?

Answer 32

Cerebral oedema ## Footnote They are particularly vulnerable and require close monitoring.

Question 33

How soon can cerebral oedema present after fluid resuscitation in DKA treatment?

Answer 33

4-12 hours ## Footnote It can occur at any time, requiring vigilance in monitoring.

Question 34

What should be done if there is suspicion of cerebral oedema in a DKA patient?

Answer 34

Seek a CT head and senior review ## Footnote Timely intervention is critical for management.