DKA

Question 1

Is ketoacidosis a more or less efficient metabolic pathway?

Answer 1

Less efficient

Question 2

In what state is the metabolic pathway of ketoacidosis used by the body?

Answer 2

Starvation state

Question 3

What byproduct does ketoacidosis produce?

What does this cause?

Answer 3

Acetone

Fruity breath smell

Question 4

What is the typical picture of DKA?

Answer 4

Vomiting
Dehydration
Gradual drowsiness

Usually type 1

Question 5

Which type of diabetes does DKA more commonly occur in?

Answer 5

Type 1

Question 6

How is DKA diagnosed?

Answer 6

1. Acidaemia (venous blood pH <7.3) OR (HCO3- <15mmol/L)
2. Hyperglycaemia (BG 11+ mmol/L)
3. Ketonaemia (3+ mmol/L) OR ketonuria (2+ on dipstick)

Question 7

What are the investigations of DKA?

Answer 7

ECG
CXR
Urine (dipstick + MSU)
Blood
  Capillary + lab glucose
  Ketones
  pH (use venous blood)
  U&E
  HCO3-
  Osmolality
  FBC
  Blood culture

Question 8

What will be seen on an ECG of DKA?

What are these changes caused by?

Answer 8

Tall T waves
Prolonged QT interval
Broad QRS complex

Hyperkalaemia
Hypocalcamia

Question 9

Why is a CXR done for DKA?

Answer 9

To rule out chest infections e.g pneumonia

Question 10

What will be seen on a urine dipstick of DKA?

Answer 10

Ketonuria (2+ on dipstick)

Question 11

What will be seen on capillary and lab blood glucose in DKA?

Answer 11

11+ mmol/L

Question 12

What will be seen on blood ketone tests in DKA?

Answer 12

3+ mmol/L

Question 13

What will be seen on blood pH tests in DKA?

Answer 13

<7.3

Question 14

What will be seen in U&Es in DKA?

What is the cause of this?

Answer 14

High urea/creatinine

Dehydration / reduced renal function

Question 15

What will be seen on HCO3- blood tests in DKA?

Answer 15

<15 mmol/L

Question 16

What are the criteria for severe DKA?

Answer 16

One of

Ketones 6+ mmol/L
Venous bicarbonate <5 mmol/L
Venous/arterial pH <7
K <3.5 mmol/L
GCS <12
O2 sat <92%
Syst BP < 90
Pulse 100+ / <60
Anion gap 16+

Question 17

What should be done in severe DKA?

Answer 17

Send to ICU

Get senior help

Question 18

What is the general management of DKA?

Answer 18

Replace vol and correct metabolic defects

Question 19

What is the first thing in DKA management?

Answer 19

Start 1L 0.9% saline over 1h
If syst BP <90 then 500ml bolus over 15 mins
If still <90 then 500ml bolus + senior review
If still <90 then ICU

Question 20

What is the insulin management of DKA?

Answer 20

Add 50 units to 50ml 0.9% saline
Infuse that @ 0.1 units/kg/h

Aim for
0.5mmol/L/h fall in blood ketones
OR 
3 mmol/L/h rise in venous bicarbonates
OR
3 mmol/L/h fall in blood glucose

Question 21

What should be checked hourly when DKA is being managed?

Answer 21

Ketones

BG

Question 22

Why are the K needs checked in DKA management?

Answer 22

Because insulin treatment will cause K to go into cells which could cause hypokalaemia

Question 23

What are the complications of DKA?

Answer 23

Cerebral oedema (get help if sudden CNS decline)
Aspiration pneumonia
Hypokalaemia
Hypomagnesaemia
Hypophospataemia
Thromboembolism

Question 24

How can DKA be prevented?

Answer 24

Talk 2 patient
Evaluate compliance
Educate about triggers