4. Diabetic Ketoacidosis (DKA), Hyperglycemic Hyperosmolar State (HHS) Flashcards
diabetic ketoacidosis is usually triggered by what ?
infection = increases glucose concentration therefore needing insulin
what is the pathopshyiology of diabetic ketoacidosis ?
heavy insulin deficicny = triggers insulin antagonising hormone glucagon , cortisol and catecholamines
= induce glycogenolysisi , gluconeogensisi = hyperglycaemia
lipolysis = acetyl co produced = production of ketone bodies = metabolic acidosis
what are the symptoms of diabetic ketoacidosis ?
constant vomitting = dehydration = hypotonia
hypovolumic shock
kussmal breathing
acetone odour of breath
patient turn sleepy = prestage of coma
hypokalaemia = cardiac arrhythmia and ileus
what is the initial therapy for DBK?
rehydration = lactated ringer solution / isotonic solution 1-3l for the first hour 1l second hour 1l following 2 hr 1l ever 4 hour
check the potassium levels FIRST BEFORE STARTING INUSLIN
no insulin is given until potassium is above 3.3mmol/l
give potassium chloride solution till 4.5mmol/L IS ACHIEVED
IV INUSLIN INFUSION OF 0.1 U /KG /H
regular insulin used 24 unit in 60ml off isotonic sodium chloride = until blood glue 10mmol/l
then rate of infusion the decreased 2-3 U /H
administer subcuteaous and im insulin before infusion stops
HAVE TO MONITOR POTASSIUM LEVELS WHEN giving insulin = insulin decreases potassium levels by redistributing into the cells via the sodium potassium pump
how do we know when treatment is successful
ph normal
and 2 negative samples of ketonuria
what sis the pathopshyiology of the hyerglycemic hyerosmolar state ?
develops slowly over days
glucosurea - high level of glucose draws out water aswell
however the insulin secretion is enough to avoid massive lipolysis and ketone body production
massive loss of water not compensated by drinking = hypovolemic shock = hyperosmolar state of blood
what are the symptoms of hyperglycaemia hyperosmolar state ?
polurea
polydipsia
weight loss
somnolence
what is the treatment of hyerosomalr hyperglycaemic state ?
iv fluid of 1l of sodium chloride solution per hour isotonic
rehydration done slowly due to risk of lung edema
insulin 0.15u/kg as infusion
check serum potassium