Endocrine - DKA Flashcards Preview

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Flashcards in Endocrine - DKA Deck (21):
0

Kussmaul Respirations?

Deep, rapid breathing attempts to compensate for metabolic acidosis

1

Most common cause of death in DKA?

Cardiovascular collapse from acidosis, hypovolemia, and electrolyte deficiencies

2

Most common precipitating events?

Pneumonia, UTI, MI, Trauma

3

Symptoms related to hypoglycemia and osmotic diuresis?

Polyurea, polydipsia, weight loss, visual blurring, decreased mental status

4

Symptoms related to acidosis?

Nausea, vomiting, abdominal pain, fatigue, shortness of breath

5

Usual labs in DKA?

Hyperglycemia >250
Acidosis 15
Ketosis

6

Manage of DKA?

1 fluid replacement
2 hypoglycemia correction
3 replete electrolytes
4 Clear ketones
5 Treat precipitating cause

7

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

8

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

9

How to judge resolution of ketoacidosis?

Anion gap closes and bicarb >18

10

Laboratory tests for ketones measure?

Acetoacetate and acetone but NOT beta hydroxybutyrate

11

Why shouldn't you measure serial serum ketone levels?

Insulin converts beta-hydroxybutyrate to acetoacetate, which actually increases ketones

12

Indications for bicarbonate therapy? Problems with bicarbonate therapy?

PH <7, cardiac instability, severe hyperkalemia

Worsening hypokalemia, paradoxical CNS acidosis, delay in ketone clearance

13

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



14

Managing DKA: Phosphate

The place if serum phosphate <1 mg/dL with hypoxia, anemia, or cardiorespiratory compromise

15

Rare but serious complications to DKA?

Cerebral edema, ARDS, thromboembolism, acute gastric dilatation

16

Symptoms of hyperosmolar nonketotic diabetic coma?

Glucose >1000
Serum osmolarity >320
Confusion, seizures, or coma

17

HONK: treatment?

1 Volume resuscitation
2 insulin to reverse hyperglycemia (but lesser doses than DKA)

18

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

25

Causes of Ketoacidosis?

DKA
Starvation
Alcoholism

26

Most accurate measure of the severity of DKA?

Low bicarb

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