[Endo] Diabetic Ketoacidosis Flashcards
(32 cards)
what is diabetic ketoacidosis (DKA)?
diabetic emergency typically seen in T1DM and to a lesser extent, T2DM
what is DKA defined as?
- hyperglycaemia >11 mmol/L
- ketones ≥3 mmol/L (blood) or ≥2+ in urine (serum more accurate)
- acidaemia pH <7.1 or bicarb <15 mmol (caused by ketone bodies)
what is the 1st line ix for DKA?
venous blood gas and serum ketones
what are the initial ix for DKA?
- blood ketones
- capillary blood glucose
- venous blood gas
- FBC, U+E, blood cultures
- MSU (midstream specimen urine)
- ECG
- CXR (if indicated)
- continuous cardiac monitoring
you think a pt has DKA. you perform an A-E assessment. what next?
give 1L 0.9% NaCl over 1 hour (stat if systolic BP <90mmHg)
you gave 1L 0.9% NaCl, what next?
commence Fixed Rate Insulin Infusion (FRII) 0.1 units/kg/hour of Actarapid / Humulin S
until when should you continue FRII for?
until blood ketones <0.6, pH >7.3+ / HCO3 >18
what do you do when glucose <14 mmol/L?
replace with 10% glucose
what is the fluid mx like for DKA over 1-12 hours?
0.9% NaCl (1L) + KCl over 2 h ↓ 0.9% NaCl (1L) + KCl over 2 h ↓ 0.9% NaCl (1L) + KCl over 4 h ↓ 0.9% NaCl (1L) + KCl over 4 h ↓ 0.9% NaCl (1L) + KCl over 6 h
what should be assessed hourly?
blood ketones and CBG
- blood ketones should fall by 0.5 mmol/L/hr
- bicarb should rise by 0.5 mmol/L/hr
- blood glucose should fall by 3.0 mmol/L/hr
if not: increase FRII by 1.0 unit/hr
how often should you check VBG for pH, HCO3 and K+?
at 60 mins
at 2 hours
and then 2 hourly
what should you assess at 12 hours?
cardiovascular status
do you need to replace potassium if K+ >5.5?
no
do you need to replace potassium if K+ 3.5-5.5?
yes + 40mmol to NaCl
what do you do if K+ <3.5?
senior review, may need to go to HDU
when should DKA resolve if appropriately treated?
within 12-24 hours
if the pt is not eating/drinking, what do you do?
continue IV fluids and commence VRII
if the pt is eating/drinking, what do you do?
commence subcutaneous insulin* 1 hour before stopping FRII
*involve diabetes specialist team for advice
what should you treat in DKA?
the precipitating cause
what complications do you need to reassess for in DKA?
- hypoglycaemia
- hypo/hyperkalaemia
- pulmonary and cerebral oedema
what are the signs of hypokalaemia?
- muscle weakness
- hypotonia
- hyporeflexia
- cramps
- tetany
what are the causes of hypokalaemia?
- drugs (K+ wasting diuretics, insulin, steroids, terbutaline)
- vomiting and diarrhoea
- Conn’s
- Cushing’s
- renal tubular acidosis (type 1)
- hypomagnesemia
what are the ECG changes seen in hypokalaemia?
- small T waves
- prominent U waves
- depressed ST segment
- prolonged PR interval
what is the rx for hypokalaemia?
- KCl
- sando-K
- stop K+ wasting drugs
