DKA Flashcards by Kappa Epsilon Pi Chapter

DKA or HHS or both?

Absolute Insulin Deficiency

DKA

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DKA or HHS or both?

Lipolysis –> FFA

DKA

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DKA or HHS or both?

increased inflammatory mediators and CV risk factors can cause it

Both!!

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DKA or HHS or both?

Relative insulin deficiency

HHS

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DKA or HHS or both?

SEVERE dehydration

HHS

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DKA or HHS or both?

Increased counterregulatory homrones

both!

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DKA or HHS?

usually has high glucose levels than the other

HHS (has SEVERE hyperglycemia)

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DKA or HHS or both?

has increased total body ketones

both

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DKA or HHS or both?

More common in type 1

DKA

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DKA or HHS or both?

more common in type 2

HHS

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DKA or HHS or both?

Metabolic Acidosis

DKA

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DKA or HHS or both?
Occurs quickly (~ 24 hrs)

DKA

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DKA or HHS or both?

Occurs over several days

HHS

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Precipitating factors for DKA and HHS

medications
inadequate insulin therapy
INFECTIONS
CV events
Pancreatitis

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Types of medications that precipitate DKA/HHS

Diuretics, corticosteroids, Sympathomimetics,

Anticonvulsant, Antipsychotics

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Symptoms seen in DKA and HHS

Polyuria
Polydipsia
Wt loss
N/V/D (more DKA…)
Dehydration
weakness
mental status change

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DKA or HHS or both?

Kussmaul respirations

DKA

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DKA or HHS or both?

Fruity breath

DKA

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DKA or HHS or both?

N/V/D

DKA

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DKA or HHS or both?

Poor skin turgor

both

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DKA or HHS or both?

Tachycardia

both

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DKA or HHS or both?

Hypotension

both (bc vasodilation)

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DKA or HHS or both?

Normothermic or Hypothermic

both

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DKA or HHS or both?

Seizures

HHS

DKA or HHS or both? | Coma

HHS

DKA or HHS or both? | Lethargy

HHS

Labs that are looked at for DKA/HHS

- Chem7 - Arterial blood gas - Hemoglobin A1c - CBC w/ differential (bc infection) - Urinalysis - Plasma osmolality - Electrocardiogram - Urine, sputum, blood cultures

DKA Lab Values: | Glucose level seen in DKA

> 250 mg/dL

DKA Lab Values: | Arterial pH

acidotic so less than 7.35!! (severe is like 7)

DKA Lab Values: | HCO3- levels

less than 24!! (severe is like 10)

DKA Lab Values: | Anion gap

> 12

Anion Gap Eqn

Na - Cl - HCO3

Serum Osmolality Eqn

(2 x Na) + (glucose/18)

Corrected Serum Sodium Eqn

Na + 0.016(glucose - 100)

For DKA and HHS: | Is BUN decrease or increased?

increased!!

What other things can cause ketoacidosis other than DKA

- starvation ketoacidosis (bicarb usually wont be less than 18....) - Alcoholic Ketoacidosis

What other things can cause high anion gap metabolic acidosis

- lactic acidosis - Ingestion of medication (salicylate, menthol, ethylene, glycol, paraldehyde) - Chronic renal failure

what is CrCl equation?

(140 - age) (IBW) / (72 x SCr) | multiplied by 0.85 if woman

How to treat DKA/HHS

1 - IV fluids 2 - insulin 3 - electrolyte replacement

Goals of Therapy with Fluid Replacement in DKA/HHS: _______ of intravascular, interstitial, intracellular volume Restoration of _________ Avoidance of ___________ Correcting deficit within _______

Expansion; renal perfusion, cerebral edema, 24 hours

Fluid replacement for DKA/HHS: initial therapy _______ at what type of rate?

0.9% NaCl @ 15 - 20 mL/kg/hr OR 1 - 1.5 L during 1st hour

Fluid replacement for DKA/HHS: | Subsequent Therapy if LOW SODIUM

Continue 0.9% NaCl | Rate = 250 - 500 mL/hr

Fluid replacement for DKA/HHS: | Subsequent Therapy if NORMAL/HIGH SODIUM

Switch to 0.45% NaCl | Rate = 250 - 500 mL/hr

Fluid replacement for DKA/HHS: Subsequent Therapy If Glucose is <200 (DKA) or < 300 (HHS).... do what?

Switch to D5W in 0.45% NaCl

Do not start insulin therapy if _________ is present

hypokalemia | if K+ is less than 3.3 mEq/L

Do not start insulin if K+ is less than ______

3.3 mEq/L

How to give insulin for DKA/HHS: | Given as BOLUS

Bolus: 0.1 units/kg THEN continuous infusion @ 0.1 units/kg/hr

How to give insulin for DKA/HHS: | Given as NO BOLUS

Continuous IV infusion at 0.14 units/kg/hr

How to give insulin for DKA/HHS: Can decrease infusion rate to ____ units/kg/hr once glucose is < _____ in DKA OR < _____ in HHS

0.02 - 0.05; 200; 300

What factors can cause decrease in serum K+

insulin therapy; correction of acidosis; volume repletion

Potassium Goal during DKA/HHS: ?

4 - 5 mEq/L

Can start K+ replacement when K+ is ______

< 5.3 mEq/L

How to replace K+ (via fluids)

20 - 30 mEq KCl in each liter of fluid replacement

Pts that come to get medical attention with DKA/HHS - generally have _____kalemia but are at risk for ______kalemia

HYPER; HYPO

How to prevent cerebral edema?

Gradual replacement of Na/H2O (NMT 50/mL/kg in first 4 hours!!!)

DKA is resolved when what happens?

``` 1 - BG < 200 AND ONE OF THE FOLLOWING - serum bicarb > 15 - Venous pH > 7.3 - Anion Gap < 12 mEq/L ```

HHS is resolved what happens?

1 - BG < 300 2 - Normal osmolality 3 - Normal mental status

when to transition from IV insulin to SQ insulin?

Pts hyperglycemic crisis has resolved | Pt is eating