CLIPP 16 - DKA Flashcards

1
Q

Dehydration PE findings (10)

A

AMS, tachycardia, dry mucous membranes, dry eyes, reduced/absent tears, decreased UOP, sunken fontanel, dry/clammy skin, decreased skin turgor, slow capillary refill

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2
Q

3 types of dehydration and appropriate rehydration methods

A
  • 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
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3
Q

Volume deficit calculation

A
  • Pre-illness weight = Current weight / [(100 - % dehydrated) x 0.01]
  • replace if stool output is greater that 1mg/kg/hr
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4
Q

Bolus fluids calculation

A

20 mL/kg over 60 minutes

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5
Q

MIVF calculation

A
-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)
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6
Q

common presenting signs of DKA (6)

A
  • vomiting
  • weight loss
  • dehydration
  • shortness of breath
  • abdominal pain
  • AMS
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7
Q

DKA pathophysiology

A

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

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8
Q

Early management of DKA (4)

A
  • rehydration
  • electrolyte monitoring
  • insulin therapy (.1u/kg/hr)
  • DO NOT GIVE BICARB
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9
Q

Why are kids more prone to dehydration? (3)

A
  • higher SA:Body mass ratio
  • higher basal metabolic rates
  • higher percentage of body weight that is water
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10
Q

DKA diagnostic criteria (4)

A
  • random blood glucose of >200 mg/dL
  • venous pH <7.3
  • serum bicarb <15mEq/L
  • ketonuria or ketonemia
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11
Q

DMI Diagnostic criteria (4)

A
  1. symptoms of diabetes + random blood glucose >200mg/dL
  2. fasting blood glucose >126 mg/dL
  3. glucose tolerance test with 2 hour postload blood glucose >200mg/dL
  4. HbA1c >6.5%
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12
Q

Lab abnormalities in DKA (8)

A
pH: decreased
Na: decreased
K: normal
bicarb: decreased
Cr: elevated
glucose: elevated
serum ketones: elevated
urine ketones: elevated
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13
Q

Corrected sodium calculation

A

([glucose]-100)/100 + [Na}

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14
Q

Cerebral edema risk factors (4)

A
  • high BUN at presentation
  • profound acidosis with hypocapnia
  • attenuated rise in measured serum sodium with treatment
  • administration of bicarb
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15
Q

DMII Pediatric Screening and Indications (6)

A
  • 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
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16
Q

Glasgow Coma Scale Categories (3)

A
  • eye-opening response (4)
  • verbal response (5)
  • motor response (6)
  • 8 or less may require aggressive intervention
17
Q

Initial management of ill children (6)

A
  • CAB
  • bolus
  • blood glucose
  • CV monitoring
  • US
  • blood gas + electrolytes
18
Q

DKA admission orders (8)

A
  • continuous VS monitoring
  • hourly neuro checks
  • I&Os
  • insulin drip
  • serum glucose q1h
  • serum calcium, Mg, PO4
  • VBG q1h
  • urine dipstick
19
Q

Admission order components (12)

A

ADC VANDISMAL

  • Admit (floor, room, service, attending, resident)
  • Diagnosis (order of priority)
  • Condition (good, fair, guarded, critical)
  • Vitals
  • Activity
  • Nursing (I&Os, drains, wound care)
  • Diet
  • IV fluids
  • Studies
  • Medications
  • Allergies
  • Labs
20
Q

DDX vomiting and AMS (8)

A
  • DKA
  • Toxic ingestion
  • GI Obstruction
  • Increased ICP
  • Gastroenteritis
  • appendicitis
  • bacterial pneumonia
  • pyelonephritis