Flashcards in Endocrine - DKA Deck (21):
Deep, rapid breathing attempts to compensate for metabolic acidosis
Most common cause of death in DKA?
Cardiovascular collapse from acidosis, hypovolemia, and electrolyte deficiencies
Most common precipitating events?
Pneumonia, UTI, MI, Trauma
Symptoms related to hypoglycemia and osmotic diuresis?
Polyurea, polydipsia, weight loss, visual blurring, decreased mental status
Symptoms related to acidosis?
Nausea, vomiting, abdominal pain, fatigue, shortness of breath
Usual labs in DKA?
Manage of DKA?
1 fluid replacement
2 hypoglycemia correction
3 replete electrolytes
4 Clear ketones
5 Treat precipitating cause
Managing DKA: Fluid resuscitation?
1-2 L of normal saline within the first hour
Then correct total body water deficit at the rate of 250-500 mL/hour
More gentle hydration in patients with CHF
Managing DKA: Insulin
1. IV bolus of 0.1 units per kilogram
2. Continuous infusion of 0.1 units per kilogram per hour
3. Slow rate of infusion to 0.05 and add 5DW when blood glucose becomes <300
How to judge resolution of ketoacidosis?
Anion gap closes and bicarb >18
Laboratory tests for ketones measure?
Acetoacetate and acetone but NOT beta hydroxybutyrate
Why shouldn't you measure serial serum ketone levels?
Insulin converts beta-hydroxybutyrate to acetoacetate, which actually increases ketones
Indications for bicarbonate therapy? Problems with bicarbonate therapy?
PH <7, cardiac instability, severe hyperkalemia
Worsening hypokalemia, paradoxical CNS acidosis, delay in ketone clearance
Managing DKA: Postassium
Add potassium when serum concentration <5
Once adequate urine output is established at 20 to 40 mEq potassium to each liter of fluid
Goal: maintain potassium between 4 to 5 mEq
Managing DKA: Phosphate
The place if serum phosphate <1 mg/dL with hypoxia, anemia, or cardiorespiratory compromise
Rare but serious complications to DKA?
Cerebral edema, ARDS, thromboembolism, acute gastric dilatation
Symptoms of hyperosmolar nonketotic diabetic coma?
Serum osmolarity >320
Confusion, seizures, or coma
1 Volume resuscitation
2 insulin to reverse hyperglycemia (but lesser doses than DKA)
Alcoholic ketoacidosis: Typical patient? Mechanism? Signs and symptoms? Tx?
Develops in alcoholics who are malnourished and have depleted glycogen stores
Decreased NADH, inhibiting gluconeogenesis
Anion gap metabolic acidosis due to ketoacidosis and lactic acidosis
Similar symptoms of DKA, But only slightly elevated glucose
Volume and glucose solution
Causes of Ketoacidosis?