CLIPP 16 - DKA Flashcards
Dehydration PE findings (10)
AMS, tachycardia, dry mucous membranes, dry eyes, reduced/absent tears, decreased UOP, sunken fontanel, dry/clammy skin, decreased skin turgor, slow capillary refill
3 types of dehydration and appropriate rehydration methods
- Isotonic/Isonatremic (Na=130-150): replace over 12 hours
- hypotonic/hyponatremic (Na<130): replace over 24 hours to avoid central pontine myelinolysis
- hypertonic/hypernatremic (Na>150): replace over 48 hours to avoid cerebral edema
Volume deficit calculation
- Pre-illness weight = Current weight / [(100 - % dehydrated) x 0.01]
- replace if stool output is greater that 1mg/kg/hr
Bolus fluids calculation
20 mL/kg over 60 minutes
MIVF calculation
-Holliday-Segar method 100ml/kg/day for first 10kg 50ml/kg/day for second 10kg 20ml/kg/day for each additional kg (4-2-1 hourly rate)
common presenting signs of DKA (6)
- vomiting
- weight loss
- dehydration
- shortness of breath
- abdominal pain
- AMS
DKA pathophysiology
insulin deficiency -> excess counterregulatory hormones -> increased gluconeogenesis, lipolysis, glycogenolysis; glycolysis inhibition -> hyperglycemia and ketogenesis ->decreased blood pH, osmotic diuresis, electrolyte abnormalities, increased catecholamine release -> metabolic acidosis worsened by lactic acidosis from dehydration and poor tissue perfusion
Early management of DKA (4)
- rehydration
- electrolyte monitoring
- insulin therapy (.1u/kg/hr)
- DO NOT GIVE BICARB
Why are kids more prone to dehydration? (3)
- higher SA:Body mass ratio
- higher basal metabolic rates
- higher percentage of body weight that is water
DKA diagnostic criteria (4)
- random blood glucose of >200 mg/dL
- venous pH <7.3
- serum bicarb <15mEq/L
- ketonuria or ketonemia
DMI Diagnostic criteria (4)
- symptoms of diabetes + random blood glucose >200mg/dL
- fasting blood glucose >126 mg/dL
- glucose tolerance test with 2 hour postload blood glucose >200mg/dL
- HbA1c >6.5%
Lab abnormalities in DKA (8)
pH: decreased Na: decreased K: normal bicarb: decreased Cr: elevated glucose: elevated serum ketones: elevated urine ketones: elevated
Corrected sodium calculation
([glucose]-100)/100 + [Na}
Cerebral edema risk factors (4)
- high BUN at presentation
- profound acidosis with hypocapnia
- attenuated rise in measured serum sodium with treatment
- administration of bicarb
DMII Pediatric Screening and Indications (6)
- fasting glucose beginning at 10 years of age or onset of puberty and then every 3 years
- overweight
- maternal history of diabetes or gestational diabetes
- family hx of DMII
- non-white
- signs of insulin resistance
