Clicker tutorial on DKA

Question 1

what is the anion gap?

What might happen to the anion gap during diabetic ketoacidosis?

Answer 1

looks at difference between positive and negative ion in the body.

e.g in DKA –> bicarbonate conc goes down
but there is an increase in immeasurable anion

Question 2

List some clinical features of DKA

Answer 2

• dehydration
• insulin deficiency
• total body K+ deficiency
• -> but plasma K+ is high
• acidotic
• risk of arrhythmia, infection and dilated stomach (vomit)

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Question 3

What electrolyte disturbance might be observed with DKA?

Answer 3

• water lost in urine
• Na+ lost in urine
• K+ lost in urine
• but total body K+ is low

Question 4

How might patients present DKA

Answer 4

• polyuria
• polydipsia
• dehydration
• hyperventilation
• abdominal pain/ vomiting
• coma
• glycosuria

Question 5

In the process of bicarbonate production by the kidney, what does the carbonic dehydrase do?

Answer 5

• it converts CO2 –> H2CO3

Question 6

What are some Investigation for DKA

Answer 6

• measure capillary glucose
• measure plasma glucose
• measure creating / K+ / Na+
• FBC (normal WBC go up in infection)
• arterial blood gas ( look at Co2 + PH levels )
• look at ECG / cardiac monitor (due to increased risk of arrhythmia)
• CXR

Question 7

how would you treat DKA

Answer 7

• give fluid
• give insulin IV (varying according to blood glucose level)
• check potassium level
• check HCO3- level (but DONT give bicarbonate)
• consider giving antibiotics/ heparin
• if K+ is too low = central line

Question 8

DKA presentation:

Answer 8

• education
• tell them to not stop insulin
• check glucose + modify insulin if patient is ill
• admit if patients are vomiting