Diabetic Emergencies Flashcards
What is the triad of DKA
hyperglycaemia
high anion gap metabolic acidosis
ketonaemia
What are some precipitating factors in known diabetes for DKA
inadequate insulin treatment non-compliance infection new-onset diabetes MI stroke acute pancreatitis trauma drugs
How does DKA present
Insulin deficiency causes impaired glucose utilisation as well as increased gluconeogenesis and glycogenolysis resulting in hyperglycaemia
Elevated plasma glucose increases the filtered load of glucose in the renal tubules
As the maximal renal tubular reabsorptive capacity is exceeded glucose is excreted in the urine
The osmotic force exerted by unreabsorbed glucose holds water in the tubules, thereby preventing its reabsorption and increased urine output (osmotic diruresis)
This leads to dehydration and loss of electrolytes
What are the 3 ketone bodies produced in DKA
2 ketoacids and one neutral ketone (acetone)
What might a patient in DKA present with
polyuria and polydipsia resulting in dehydration
abdominal pain and vomiting
fatigue, weakness and weight loss
confusion, coma
What is the term given to deep sighing respiration secondary to acidosis
Kussmaul’s respiration
What does the diagnosis of DKA require
plasma glucose >11mmol/L
Positive urinary ketones or plasma ketones >3mmol/L
acidosis (pH
What type of acidosis in DKA
metabolic acidosis (associated with low bicarbonate levels and a reduction of partial pressure of carbon dioxide due to compensatory hyperventilation with a high anion gap
What should be performed in any patient presenting with DAK
ECG and septic screen
What are some other causes of a high anion gap metabolic acidosis
lactic acidosis (due to tissue hypo perfusion caused by hypovolaemia, cardiac failure or sepsis) renal failure and drugs such as aspirin, methanol and ethylene glycol
What does the treatment of DKA include
Resuscitation (ABCDE) insulin fluids potassium Broad spectrum AB if infection is suspected
Why should patients remain nil by mouth for at least 6 hours
gastroparesis is common
What is the only indication for delaying insulin in DKA
a serum potassium less than 3.3.mmol/L as insulin will worsen the hypokalaemia by driving potassium into the cells
How much insulin is given in DKA
50U of soluble insulin to 50ml 0.9% saline
If the patient is not eating and drinking, what should be used in DKA
Sliding scale