Approach to diabetic patient and hypoadrenocorticism Flashcards
Summarise cause of DKA
Primarily caused by a severe deficiency of insulin in the body, most commonly associated with type 1 diabetes. In the absence of sufficient insulin, cells are unable to use glucose, leading to a reliance on fat metabolism for energy production.
This metabolic shift results in the release of ketones, acidic byproducts of fat breakdown, into the bloodstream. Accumulation of ketones leads to ketosis and an increase in the acidity of the blood,
Functions of insuline
Glucose Uptake: It promotes the movement of glucose from the bloodstream into cells, where it can be used for energy.
Glycogen Synthesis: Insulin stimulates the conversion of excess glucose into glycogen in the liver and muscle cells.
Inhibition of Glucose Production: Insulin inhibits the liver’s production of glucose. This helps prevent excess glucose release into the bloodstream, maintaining blood sugar levels within a normal range.
Protein and Fat Synthesis: Insulin promotes the synthesis of proteins and the storage of fats. It encourages cells to take up amino acids for protein formation and facilitates the storage of fatty acids in adipose tissue.
Clinical signs of ketoacidosis
Dehydration
Tachycardia
Vomiting
Haemorrhagic diarrhoea
Poor peripheral perfusion
Acidotic respiration
Collapse
Death
Complications of ketoacidosis
Urinary tract infections
Pancreatitis
Gastro-intestinal haemorrhage
Bacteraemia / septicaemia
Acute renal failure
Disseminated intravascular coagulation
Pulmonary thromboembolism
Confirmatory tests for ketoacidosis
Urinalysis
Biochemistry
What results do you expect to see from a urinalysis of a patient with ketoacidosis
Glucosuria
Ketonuria
What results do you expect to see from a Biochemistry test of a patient with ketoacidosis
Hyperglycaemia- Not in cats on SGLT2 inhibitors
Hypokalaemia
Hypophosphataemia
Azotaemia
Hepatopathy
What to do for a patient with ketoacidosis
Fluid therapy
Soluble insulin injections
Glucose supplementation needed if not eating and glucose low
Outline fluid therapy for a ketoacidosis patient
Give intravenously
K+ supplementation
PO4- supplementation
Calculate requirement for 24 hours taking into account: % dehydration, continuing losses , maintenance
20% of requirement in first hour
Outline Soluble insulin injections for a ketoacidosis patient
Little and often!
Intramuscular:
Initial dose = 0.2 IU/kg
Subsequent doses = 0.1 IU/kg every 2 to 4 hours
Monitor glucose hourly
IV:
0.03 units /kg/hour
Run 50 ml of solution through tubing before starting
Monitor glucose hourly
Treatment of hypokalaemia
10 mmol KCl per 500 ml fluids
do not exceed 0.5 mmol/kg/hr
Signs of hypophosphataemia
Haemolysis
Severe weakness,
Rhabdomyolysis
Stupor, seizures
Why can DKA cause hypophosphataemia
Insulin therapy, a key component of DKA treatment, promotes the movement of phosphate into cells, leading to a decrease in blood phosphate levels. Additionally, the loss of fluids through frequent urination, which is common in DKA, can contribute to the depletion of electrolytes, including phosphate.
Which route of injection is best to administer insulin for a ketoacidosis patient
Intramuscular
What is a common side effect of acute/chronic insulin overdose
Hypoglycaemia
