ACCS

Question 1

What is diabetic ketoacidosis?

Answer 1

raised blood glucose with metabolic acidosis (bicarb<16 or pH<7.3 on venous) and blood ketones (>3 mmol/L or ketonuria ++)

Question 2

What are the causes of DKA?

Answer 2

older age groups - infections <30y omission of insulin

Question 3

What causes DKA?

Answer 3

lack of insulin and/or rising glucagon levels, adrenaline and cortisol lead to rising glucose levels from gluconeogenesis. lipolysis raises NEFA and glycerol - liver oxidises NEFA to form acetyl CoA and then ketone bodies High glucose overcomes the capacity of the kidney to reabsorb glucose, glycosuria inhibits water reabsorption and losses of potassium

Question 4

What is concerning about vomiting in DKA?

Answer 4

The patient has 12-24 hours to live and needs emergency admission and treatment within 1 hour

Question 5

What are the principles of DKA management?

Answer 5

restore circulating blood volume replace lost electrolytes return blood glucose towards

Question 6

What are the high risk signs for DKA?

Answer 6

blood ketones >6 bicar <5 pH <7.1 GCS <12 oxygen sats <92% systolic b

Question 7

what investigations should be done in DKA>

Answer 7

urea and electrolytes BG full blood count venous bicarb/gases blood cultures consider - ABG if

Question 8

What is the early management of DKA?

Answer 8

IV fluids - 1 2h, 1 in 4h, 1 in 6h -be guided by urine output potassium - often high/normal initially but total body potassium is low. Add potassium to IV infusion Insulin - IV insulin at 0.1 unit/kg/hr. Insulin levels need to remain high to turn off ketogenesis

Question 9

What is HHS?

Answer 9

Hyperosmolar hyperglycaemia state

Question 10

What is the triad of HHS signs?

Answer 10

hypovolaemia hyperglycaemia (usually >30 osmolality >320

Question 11

Which has the higher mortality, HHS or DKA?

Answer 11

HHS