Diabetic Ketoacidosis Flashcards
1
Q
What is Diabetic Ketoacidosis and Who gets Diabetic Ketoacidosis?
A
Diabetic Ketoacidosis is a severe metabolic complication of diabetes, and is generally only seen in patients with Type 1 Diabetes Mellitus.
2
Q
What characterises Diabetic Ketoacidosis biochemically?
A
Biochemically, DKA is characterised by a triad of:
- Hyperglycaemia (>11mmol/L)
- Ketonaemia (>= 3mmol/L or significant ketonuria +++ on urine dipstick).
- Acidosis (Bicarbonate <15mmol/L and/ or Venous pH <7.3).
3
Q
What usually precipitates DKA?
A
In the majority of cases, DKA is precipitated in patients with diagnosed T1DM. However, in 10-20% of patients it can be the first presentation of T1DM.
The most common precipitant of DKA is infection, followed by non-compliance and inappropriate dose alteration.
4
Q
Explain the pathophysiology of DKA?
A
- The lack of insulin in the body means glucose sits in the blood as is unable to be uptook into cells causing hyperglycaemia.
- As the body cells are starving for glucose, there is an increase in the glycogenolysis to produce glucose bu breaking down glycogen and also an increase in the synthesis of glucose from other substrates via gluconeogenesis.
- Eventually, these processes are exhausted and lipolysis ensues which results in lipolysis to produce free fatty acids which can be used as an alternative energy source via Ketogenesis.
- Ketogenesis results in the production of Ketone Bodies (Acetoacetate, Hydroxybutyrate and acetone).
- Ketone bodies are all week acids and cause a metabolic acidosis. The main ketone body implicated in DKA is beta-hydroxybutyrate.
- Plasma glucose levels continue to rise which causes a severe osmotic diuresis which can cause major hypovolaemia, electrolyte abnormalities, confusion and coma.
5
Q
How does Diabetic Ketoacidosis Present?
A
- Nausea.
- Vomiting.
- Abdominal Pain.
- Polyuria & Polydypsia.
- Dehydration.
- Ketotic breath (pear-drop smell)
- Kussmaul breathing (deep sighing breathing, intended to blow off CO2).
