Alcohol withdrawal

Question 1

Define Diabetic ketoacidosis (DKA)

Answer 1

Acute complication of Diabetes
Lack of insulin which causes lived to believe they are starving -> goes into Ketoacidosis pathway-not efficient
Will cause death quite quickly

Define as academia, Hyperglycemia and Ketoaneamia

severe DKA if ph<7.1, K low, GCS <12, Ketones >6, etc

Question 2

Aetiology and risk factors of DKA

Answer 2

Lack of insulin causes liver to believe its out of sugar-(can’t get in cells without insulin)-ketoacidosis pathway-

Risk factors
Inadequate DM monitoring
Most typical trigger is Infections-systemic response to increase glucose
MI can cause DKA via counter regulatory Hormones

Question 3

Epidemology of DKA

Answer 3

More and more common In type 2d as they get pancreatic failure-used to be rare AF

even T1dm increasing

about 20-per 100 person with diabetes

Question 4

Symptoms and signs of DKA

Answer 4

Drowsiness, vomiting and dehydration in T1DM (not t2DM)
Adbominal pain

Hyperventilation (cause of acidosis)
Reduced conciousness
Hypothermia

Acetone smell in breath

Question 5

Investigations for DKA

Answer 5

ECG-Weird T waves, evidence of hypokalaemia (u wave)(or hyper (peaked T))
, CXR-can have oedema

Dipstick-expect ketoneuria
Bloods-regular, high BM, high Ketone, low K+, low Na

VBG-metabolic acidosis (maybe compensated)
Lactate

care-
not all ketone=ketoacidosis
plasma glucose not always raised
serum amylase might be high

Question 6

Management of DKA

Answer 6

Insulin immediately-monitor falling ketones
Check for K+ replacement
-avoid hypokalaemia (fluids wth it)
Ensure no hypoglycemia
Ensure no Hypokalemia
Avoid hypo bicarb

Question 7

Complications of DKA

Answer 7

Cerebral Oedema-if sudden CNS drop get help
Aspiration Pneumonia
Hypokalaemia
Hypomagnesium, hypophosphatmia
thromboembolism

Question 8

Prognosis of DKA

Answer 8

Mortality of DKA has dropped dramatically