Chapter 20 - Fluid therapy in endocrine and metabolic disorders Flashcards
Most animals with DKA have concurrent diseases. Name 6.
Pancreatitis, UTI, Cushings, neoplasia, hepatic disease, renal failure
T/F: Many dogs with uncomplicated DM will have ketonuria at the time of diagnosis.
True
Where are ketoacids derived from?
Free fatty acids present as a consequence of lipolysis that undergo beta oxidation
T/F: Use of ketones is impaired in DKA.
True
How do you correct for serum Na when hyperglycemia is present?
Add 1.6mEq/L to Na concentration for every 100mg/dl plasma glucose is over 100mg/dl
T/F: Base deficit does not appear to have an impact on prognosis in patients with DKA.
False, worsening prognosis with worsening base deficit
What are the benefits of starting fluid therapy before administration of insulin? (5)
Reduces insulin resistance, increases insulin availability to the peripheral tissues, dilutes BG, enhances urinary loss following an increase in GFR, increases volume and perfusion
What is the median measured osmolality in cats with DKA?
353 or 333mOSM/kg (280-300)
What contributes to the hyperosmolality in DKA (3)?
Hyperglycemia, azotemia and ketone bodies
What happens in DKA patients where the plasma osmolality is corrected too quickly?
Cerebral edema
How quickly does the author recommend replacing the volume deficits when initiating fluids?
12-24 hours, with 50% being replaced in the first 4-6 hours
When administering insulin in DKA patients, what is the goal with regards to decreasing blood glucose?
Not more than 50-75mg/dl/hr
What are the disadvantages of the low dose IM insulin protocol?
Requires a large amount of technical effort for insulin injections and BG measurements, the decrease in BG concentration occurs more rapidly and less predictably than with CRI.
What are the disadvantages of the CRI low dose insulin protocol?
Need for an infusion pump and time required to monitor BGs
T/F: Regardless of serum K concentration, almost all patients with DKA have a deficit of total body K.
True
