4. Diabetic Ketoacidosis (DKA), Hyperglycemic Hyperosmolar State (HHS)

Question 1

diabetic ketoacidosis is usually triggered by what ?

Answer 1

infection = increases glucose concentration therefore needing insulin

Question 2

what is the pathopshyiology of diabetic ketoacidosis ?

Answer 2

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

Question 3

what are the symptoms of diabetic ketoacidosis ?

Answer 3

constant vomitting = dehydration = hypotonia

hypovolumic shock
kussmal breathing

acetone odour of breath
patient turn sleepy = prestage of coma

hypokalaemia = cardiac arrhythmia and ileus

Question 4

what is the initial therapy for DBK?

Answer 4

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

Question 5

how do we know when treatment is successful

Answer 5

ph normal

and 2 negative samples of ketonuria

Question 6

what sis the pathopshyiology of the hyerglycemic hyerosmolar state ?

Answer 6

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

Question 7

what are the symptoms of hyperglycaemia hyperosmolar state ?

Answer 7

polurea
polydipsia
weight loss
somnolence

Question 8

what is the treatment of hyerosomalr hyperglycaemic state ?

Answer 8

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