DKA Flashcards
What should glucose levels in the blood be?
4.4- 6.1 mol/l
What is insulin and where is it produced?
Insulin produced in beta cella of isle of langerhans.
It is an anabolic protein meaning it is a building hormone
Increases when the blood sugar level rises
What does insulin stimulate
Cells to absorb glucose from blood
Muscle and liver cells to store it as glycogen
What is glucagon, where is it produced and what does it do
Increase Blood sugar cells
Produced in the alpha cells of the isle of langerhans
It is a catabolic protein
Tells the liver to break down glycogen into glucose
Proteins and fats into glucose
What happens when there is a prolonged period of fasting
Insufficient glucose supply
Glycogen cells are exhausted
FA into ketones
Can cross the BBB so can feed the brain
How to measure ketones in the system
Urine : urine dipstick
Blood: ketone meter
How are acidic conditions prevented when ketones are produced?
Buffered by bicarbonate produced by the kidneys
What can uncontrolled production of ketones lead to?
Metabolic acidosis
What is ketoacidosis
Build up of ketones due to lack of production of insulin.
Initially the kidney would produce bicarbonate to neutralise the acid but as this is used up the ketones lead to a build up of acid
What does hyperglycemia lead to?
Hyperglycemia overwhelms the kidneys and glucose begins to be filtered into the urine.
Glucose in the urine drags water with it- osmotic diuresis
Polyuria
Polydipsia
What happens to potassium?
Potassium is not being stored in cells due to lack of insulin
What happens when insulin treatment is first started?
Hypokalaemia- potassium taken up by cells
This can lead to arrhythmias
Presentation of DKA
Polyuria Polydipsia Nausea and vomiting Acidotic breath Dehydration and hypotension Altered consciousness Symptoms of underlying trigger e.g. sepsis
Management
Fluid resuscitation
Insulin infusion
Diagnosis of DKA
Hyperglycemia: >11mmol/l
Blood ketosis : over 3mmol/l
Acidosis : ph<7.3 or bicarbonate low
