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PCH2 - Conditions > Diabetic Ketoacidosis > Flashcards

Diabetic Ketoacidosis Flashcards

1
Q

In DKA, why does the body go into a starvation-like state?

A

glucose cannot be taken up into cells due to lack of insulin, so ketosis is the only mechanism of energy production

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2
Q

what is the typical picture of ketoacidosis in terms of symptoms?

A

drowsiness
vomiting
dehydration

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3
Q

What is the most common cause of Kussmaul hyperventilation?

A

Diabetic ketoacidosis

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4
Q

Can DKA result in abdominal pain?

A

yes

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5
Q

What signs are present in DKA related to water input and output?

A

Polyuria
Polydipsia

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6
Q

List 6 triggers for DKA

A

infection
antipsychotics
myocardial infarction
chemotherapy
surgery
wrong insulin dose/ non-compliance

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7
Q

List the criteria for diagnosing DKA

A
  1. Blood glucose >11.0mmol/L or known diabetes mellitus
  2. Acidaemia (venous blood pH <7.3)
  3. Serum bicarbonate <15mmol/L
  4. Ketonuria (++ or above) or ketonaemia (>= 3.0mmol/L)
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8
Q

When should the patient be transferred to ICU for central venous access and monitoring?

A

If any of these occur:

  1. Blood ketones >6
  2. Venous bicarbonate <5
  3. Venous/ arterial pH <7
  4. K <3.5 on admission
  5. GCS <12
  6. O2 <92% on air
  7. Systolic BP <90
  8. Pulse >100 or <60
  9. Anion gap above 16
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9
Q

True or false: In DKA, plasma glucose is always high

A

false

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10
Q

True or false: High WCC always means infection

A

false

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11
Q

True or false: Infection always presents with fever in DKA

A

false

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12
Q

Why does plasma creatinine in DKA not represent true renal function?

A

Some assays for creatinine cross-react with ketone bodies so do not reflect true renal function

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13
Q

True or false: MSU, blood cultures and CXR are not necessary in DKA

A

false, they are necessary if suspect infection: common trigger

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14
Q

True or false? If sodium is within range, that means that the patient does not have severe water loss

A

False

Normal or high Na+ indicates severe water loss

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15
Q

Ketonuria does not always equate with ketoacidosis

A

True

Anyone may have up to ++ ketonuria after an overnight fast. Not all ketones are due to diabetes - consider alcohol and always check venous blood ketones

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16
Q

True or false: blood glucose may return to normal long before ketones are removed from the blood, so maintain a constant rate of insulin infusion (with co-infusion of glucose) until blood ketones <0.6mmol/L and pH<7.3mmol/L

A

True

17
Q

True or false? Serum amylase can be raised up to 10x in DKA in the absence of DKA

A

True

18
Q

What percentage saline should be given initially in DKA, how much and for how long?

A

0.9%
1L
1hour

19
Q

Venous or arterial blood gas should be used initially for DKA?

A

venous blood gas

20
Q

True or false: In DKA a catheter should be considered in patients who have not passed urine in 1 hour since commencing treatment

A

true

21
Q

In DKA, at what point should you start 10% glucose infusion?

A

<14mmol/L plasma glucose

22
Q

In DKA, you should continue fixed-rate insulin infusion until ketones, bicarb and pH reach what level?

A

Ketones <0.6mmol/L
Venous pH >7.3
Venous bicarb >15mmol/L

23
Q

True or false: you should continue infusing insulin in DKA until urinary ketones are no longer testing positive

A

false

These can stay positive even after the DKA is resolved

24
Q

True or false: it is important to find and treat the cause of DKA?

A

True

25
Q

DKA is a cause of vomiting

A

True

26
Q

What is the threshold for severe hypophosphataemia?

A

<0.4mmol/L

27
Q

True or false: DKA can cause acute, non-specific abdominal pain

A

True

28
Q

What are ECG signs of hypokalaemia?

A
  • Small or inverted T waves
  • Prominent U waves
  • Long PR interval
  • Depressed ST segments
29
Q

What are the symptoms of hypokalaemia?

A
  • Muscle weakness, hypotonia or hyporeflexia
  • Cramps
  • Tetany
  • Palpitations
  • Light-headedness
  • Constipation
30
Q

What is the diagnosis?

A

Hyperkalaemia

  • Flattening of P waves
  • Prominent T waves
  • Widening of QRS complex
31
Q

What are the symptoms of hypomagnesaemia

A
  • Paraesthesiae (pins and needles)
  • Ataxia
  • seizures
  • Tetany
  • Arrythmias
32
Q

Plasma magnesium concentration tends to follow that of which two ions?

A

Ca2+

K+

33
Q

In which situations should fluid resuscitation be used?

A
  • Hypovolaemic shock
  • Dehydration or hypovolaemia
34
Q

What are the signs and symptoms of hyperkalaemia?

A
  • Fast irregular pulse
  • Chest pain
  • Weakness
  • Palpitations
  • Light-headeness
  • ECG changes
35
Q

Why is hypokalaemia a complication of DKA?

A

Insulin drives potassium into cells

36
Q

What are the complications of DKA?

A
  • Cerebral oedema
  • Aspiration pneumonia
  • Hypokalaemia
  • Hypomagnesaemia
  • Hypophosphataemia
  • Thromboembolism

PCH2 - Conditions (12 decks)

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