Flashcards in DKA Deck (19):
What is the typical progression of DKA?
Gradual drowsiness, vomiting and dehydration in a T1DM
What symptoms can DKA present with?
Dry mucous membranes
Poor skin turgor
Kussmaul breathing (rapid and deep)
Altered mental state
What are the major risk factors for DKA in a T1DM?
Inadequate or inappropriate insulin therapy
What venous bloods are required in DKA?
What tests (other than venous bloods) should be done in DKA?
What are the 3 things required to make a diagnosis of DKA?
What are the criteria for diagnosing severe DKA?
pH <7.1 or HCO3 <5 or H+ >80
When in DKA should a senior be called immediately?
Hypokalaemia on admission
Reduced conscious level
What immediate actions should be done for someone in suspected DKA?
Check U&Es and lab BG
Check urine or blood ketones
Record time of arrival
Confirm age of patient (different protocol for those <16)
What criteria is needed from a venous blood gas to confirm a diagnosis of DKA?
H+ >45 or HCO£ <18 or pH <7.3
What management should be commenced within the first 30 mins of arrival?
Commence IV NaCl 1L over 1 hour
Commence soluble insulin 6units/hour (actrapid)
What management should be commenced within the first hour of arrival?
What management should be done within hours 1-4?
NEWS, ECG and GCS
Hour 2 = 1L Nacl + KCl
Hours 3-4 = 500ml/hour NaCl + KCl
Review K+ result and prescribe KCl based on result
Check fingerprick glucose hourly
Lab glucose, U&Es and HCO3 at hours 2 and 4
How many mmol K+ should be given if K+ level recorded as >5 or if patient is anuric?
How many mmol K+ should be given if K+ level recorded as 3.5-5?
How many mmol K+ should be given if K+ level recorded as <3.5?
What should be done if BG falls to <14 within 4 hours?
Start Glucose 10% 500mls with 20mmol KCl at 100ml/hour
Continue NaCl at 400mls/hour +KCl until end of hour 4
Reduce insulin to 3units/hour
Maintain BG >9 and <14
Move on to secondary protocol
What 3 criteria must a patient meet before the can be discharged following a DKA episode?
On usual daily SC insulin regimen