10 minute topic DKA, HHNK and HHS

Question 1

What is happening in DKA?

Answer 1

Body uses fat instead of glucose
Ketones are a waste product of fat breakdown
Ketones build up in the blood

Question 2

Sx of DKA

Answer 2

Polyuria causing dehydration
N/V, abd pain
Kussmaul respiration
Altered mental status

Question 3

Dx of DKA

Answer 3

BS > 250mg/dl
Ketone positive in urine/blood
Acidotic, pH < 18
Low C02 in the blood

Question 4

IV fluids for DKA

Answer 4

start with NS then switch to D5 ½ when blood sugar is less than 250mg/dL

Question 5

How much to decrease BS per hour?

Answer 5

50-75 mg/dl/hr

Question 6

DKA causes`

Answer 6

Illness
MI
CVA
Trauma
Surgery
Stress
Meds – ie Steroids

Question 7

When to monitor for ketones

Answer 7

if the PT is sick or BS consistantly >300

Question 8

HHNK/HHS

Answer 8

Hyperosmolar Hyperglycemic Non-Ketotic Syndrome

Question 9

HHNK/HHS sx

Answer 9

polyuria
BS > 600 mg/dL can be as high at 1500 mg/dL
Tachycardia
Drowsiness 
no fruity breath

Question 10

Acetones

Answer 10

ketones in the blood

Question 11

Treatment of HHNK/HHS

Answer 11

Rehydrate w/ NS then D5 ½ NS

IV insulin

Question 12

When to convert from IV to SQ insulin

Answer 12

BS <200 and patient is eating

Question 13

Similarities between DKA & HHNK/HHS

Answer 13

High risk of coma/death
Treated with IV insulin
Increased urination leads to severe dehydration
Watch electrolytes closely especially K+, MG & Phos