CLIPP 16 Flashcards
name 3 reasons why children are at higher risk for dehydration
they have a higher surface area:body mass ratio
higher basa metabolic rates
higher percentage of body weight that is water
What are common symptoms of DKA?
vomiting
weight loss
dehydration
shortness of breath
abdominal pain
change in LOC
What are the 3 diagnostic criteria for DKA?
random blood glucose of > 200 mg/dL
venous pH < 7.3 or serum bicarb < 15 mEq/L
Moderate or large ketonuria or ketonemia
What is the pathophysiology of DKA?
decreased insulin causes counterregulatory hormones to be secreted
increased gluconeogenesis and lipolysis
increased glucose –> increased water in vessels –> increased water loss
increased free fatty acids –> ketone production
describe whether the following lab values in DKA will be increased, normal, or decreased: blood pH, serum Na+, serum K+, bicarb, creatinine, serum glucose, serum ketones, urine ketones
pH = decreased
serum Na = decreased (dilutional hyponatremia)
serum K = normal/elevated (depleted intracellular K+)
bicarbonate = decreased
creatinine = elevated (severe dehydration –> prerenal azotemia)
serum glucose = increased
Serum ketones = increased
urine ketones = increased
What are the 3 types of dehydration?
isotonic/isonatremic
hypotonic/hyponatremic
hypertonic/hypernatremic
over what time period (hours) shoudl patients with isotonic/isonatremic dehydration have their fluids replaced? Hypotonic/hyponatremic? Hypertonic/hypernatremic?
Isotonic/isonatremic = 12 hours
Hypotonic/hyponatremic = 24 hours
Hypertonic/hypernatremic = 48 hours
In DM 2, are insulin levels low, normal, or high?
Usually normal or high levels of insulin, but hyperglycemia exists due to insulin resistance (IR) of peripheral tissues.
when does the ADA recommend screening for DM in children?
10 years of age or at onset of puberty
What is the max score on the Glasgow Coma Scale? what score indicates aggressive intervention and management?
15 total
8 or less may require aggressive intervention and management
In a patient with dehydration and tachycardia, resuscitation with an IV fluid bolus is crucial. What type of fluid should be administered and at what rate?
isotonic saline (0.9%) at 20 mL/kg over 60 minutes
besides fluid administration, what important “drug” should be administered to a patient in DKA?
insulin
Fluid resuscitation itself will help lower the blood glucose, but only insulin will correct the metabolic derangements of DKA by suppressing lipolysis and ketogenesis.
What is the Holliday-Segar method for maintenance fluids?
100 mL/kg/day for the first 10 kg of body weight
50 mL/kg/day for the second 10 kg of body weight
20 mL/kg/day for each additional 1 kg of body weight
Why is it important to have hourly neuro checks in DKA?
to make sure the patient doesn’t develop cerebral edema
Why is it important to monitor I/O in DKA?
hydration status needs to be continually reassessed
Why is it important to administer insulin in DKA?
because insulin is the only way to reverse DKA
Why is it important to monitor serum glucose every 60 minutes in DKA?
glucose is initially monitored every 60 minutes to assess DKA reversal (along with other metabolic labs)
Why is it important to monitor Ca, Mg, and phosphorus in DKA?
DKA patients often become Mg and phosphorus depleted. When phosphorus is added, calcium must be monitored
Why is it important to monitor pH via venous blood gas in DKA?
got to make sure the acidosis is resolving
Why is it important to monitor urine ketones in DKA?
urinary ketones should decrease as acidosis resolves
there are a lot of options for subcutaneous insulin regimens, but every insulin regimen has the same two components. What are they?
basal insulin: intermediate-long acting to maintain normoglycemia in the fasting tate
prandial insulin: short acting insulin taken before meals
What is the differential diagnosis fo vomiting and altered mental status?
DKA
Toxic ingestion
GI obstruction
Increased intracranial pressure
Gastroenteritis
Appendicitis
Bacterial pneumonia
Pyelonephritis
