DKA, HHNKS, LA

Question 1

What 3 physiological conditions need to be present to be DKA?

Answer 1

1. Hyperglycemia
2. Ketoacidosis
3. Metabolic acidosis

Question 2

What are some meds that can precipitate DKA?

Answer 2

-corticosteroids
-Thiazide diuretics
-sympathomimetic drugs
-SGLT2i
-immune check inhibitors

Question 3

DKA involves _____(absolute/relative) insulin deficiency.

Answer 3

Absolute

Question 4

What are some signs and s/x of DKA?

Answer 4

-polydipsia/polyphagia/polyuria
-hyperventilation
-blurred vision
-N/V/abdominal pain

Question 5

What are the 3 physiological components to HHNKS?

Answer 5

-hyperosmolarity
-hyperglycemia
-dehydration

Question 6

DKA has higher prevalence in patients with type ___ diabetes while HHNKS has higher prevalence in patients with type ____ diabetes.

Answer 6

-DKA= type 1
-HHNKS= type 2

Question 7

Which medications can precipitate HHNKS?

Answer 7

-thiazide
-corticosteroids
-second gen antipsychotics

Question 8

HHNKS involved _____ (absolute/relative) insulin deficiency.

Answer 8

relative

Question 9

SGLT2i are associated with _____.

Answer 9

E-DKA

Question 10

What BG levels does HHNKS involve?

Answer 10

> 600

Question 11

What BG levels does DKA involve?

Answer 11

> 250

Question 12

What arterial pH categorizes DKA as severe?

Answer 12

pH<7.00

Question 13

What serum osmolality level does HHNKS involve?

Answer 13

> 320

Question 14

What arterial pH categorizes DKA as mild?

Answer 14

7.23-7.30

Question 15

What arterial pH categorizes DKA as moderate?

Answer 15

7.00-7.24

Question 16

True or false: balanced crystalloids demonstrate a shorter time to resolution of DKA and a shorter time to discontinuation of insulin infusion.

Answer 16

True

Question 17

True or false: early basal insulin showed a increased duration of insulin infusion.

Answer 17

False: early basal insulin showed a REDUCED duration of insulin infusion

Question 18

According to the guidelines, what is the approximate level of potassium that requires relating prior to insulin therapy initiation?

Answer 18

K~ 3.3 mEQ

Question 19

Which is better, the two-bag or one-bag method for management of ketoacidosis?

Answer 19

two-bag: quicker correction of acidosis, less IVG bags needed, lower occrances of hypokalemia

Question 20

What is the order of treatment paths for DKA/HHNKS?

Answer 20

1. fluids
2. electrolytes
3. insulin

Question 21

At what rate are insulin infusions started at?

Answer 21

-0.1 U/kg/hr (max 15 U/hr)

Question 22

If the patient’s pH ≥ ___, no bicarb therapy is indicated.

Answer 22

7.0

Question 23

What is the goal rate of BG decrease after giving insulin infusion?

Answer 23

60-80 mg/dL/her decrease

Question 24

What is the rate of insulin infusion once BG is less than 300?

Answer 24

0.05 U/kg/hr if necessary

Question 25

What is the normal physiological level of lactic acid in the body?

Answer 25

<2 mmol/L

Question 26

What lab values are considered with a diagnosis of lactic acidosis?

Answer 26

1. lactic acid levels >2 mmol/L 2. pH < 7.35

Question 27

What is type A lactic acidosis?

Answer 27

-lactic acid production WITH hypoxia

Question 28

What is type B lactic acidosis?

Answer 28

-lactic acid production in the ABSENCE of hypoxemia

Question 29

Type A lactic acidosis is mostly caused by ____ while type B lactic acidosis is mostly caused by________.

Answer 29

Type A lactic acidosis is mostly caused by CONDITIONS while type B lactic acidosis is mostly caused by DRUGS.

Question 30

Which drugs can cause type B lactic acidosis?

Answer 30

-alcohol -isoniazid -metformin -propofol -linezolid -HAART therapy -acetaminophen

Question 31

What are some symptoms of lactic acidosis?

Answer 31

-anxiety -N/V -tachpnea/tachycardia -SOB -arrhythmia

Question 32

How do we treat lactic acidosis?

Answer 32

1. treat root cause (ex: septic shock-> administer antibiotics) 2. fluid resuscitation with balanced crystalloids 3. vasopressors if needed