2-5-16-DM1 Case (Kirila)

Question 1

Skin tenting (turgor) is a sign of ___

Answer 1

Dehydration

Question 2

Describe Kussmaul breathing:

Answer 2

• Metabolic acidosis (DM)
• hyperpnoea
• Rapid/deep breathing

Ketones (DKA)
Uremia
Sepsis
Salicylates
Methanol
Aldehydes
(U)
Lactic acidosis

Question 3

List signs for DKA:

Answer 3

• Kussmaul respirations-rapid/deep
• Acetone (fruity) breath odor
• Dry mucous membranes
• Poor skin turgor
• Tachycardia
• Hypotension
• Fever
• Abdominal tenderness

Question 4

Plasma potassium is expected to ___ during DKA

Answer 4

Increase–> since acidosis causes K+ to shift out of cells

Question 5

What is expected of the anion gap during DKA?

Answer 5

Increased (should be between 5-16 mEq/L)

Question 6

What set of values from a CMP are used to calculate the anion gap?

Answer 6

Na, Cl, and CO2 (or HCO3)

Question 7

What does MUDPILES stand for in High Anion Gap Acidosis?

Answer 7

Methanol
Uremia
DKA
Paraldehyde
Isopropyl alcohol, Iron, Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

Question 8

When do you want to consider K+ replacement in DKA?

Answer 8

When serum [K+] is less than 5.5 mEq/L

Question 9

What are contributing factors to the development of type 1 diabetes?

Answer 9

• Genetic susceptibility
• Multiple autoimmune mechanisms possible
• Environmental factors (possible triggers), i.e., Cocksacki, enterovirus

Question 10

What are the most likely predisposing factors for DKA?

Answer 10

• Previously undiagnosed diabetes
• Infection
• Systemic illness
• Dehydration

Question 11

What are features shared by both type 1 and type 2 DM?

Answer 11

• Dehydration
• Insulin deficiency-either absolute or relative
• Glucagon excess-either absolute or relative

Question 12

What is the acute treatment for fluid replacement in DKA?

Answer 12

“1-2-3” rule

• 2-3 liters NS (Normal Saline) (0.9%) over first 1-3 hours (5-10 ml/kg/hr)
• Then, 1/2 strength saline (0.45%) at 150 ml/hr
• When glucose reaches 250 mg/dl, switch to D5 1/2 NS (5% dextrose and 0.45% saline) at 100-200 ml/hr

-Fluid deficit is often 3-5 liters

Question 13

What is the acute treatment for insulin administration in DKA?

Answer 13

Regular insulin

• 10-20 units IV or IM (IV if possible)
• then, 5-10 units/hr continuous IV (or 0.05-0.1/kg/hr)
• Increase if no response in 1-2 hours-orders can be written with guidelines to titrate

Question 14

What are the mental status changes associated with DM type 1 (AEIOU TIPS)?

Answer 14

Alcohol/acidosis
Epilepsy/Endocrine/Exocrine/Encephalopathy
Infection
Opioid/Overdose
Uremia
Trauma
Insulin
Psychosis
Syncope/Stroke