Diabetic Ketoacidosis Flashcards
In DKA, why does the body go into a starvation-like state?
glucose cannot be taken up into cells due to lack of insulin, so ketosis is the only mechanism of energy production
what is the typical picture of ketoacidosis in terms of symptoms?
drowsiness
vomiting
dehydration
What is the most common cause of Kussmaul hyperventilation?
Diabetic ketoacidosis
Can DKA result in abdominal pain?
yes
What signs are present in DKA related to water input and output?
Polyuria
Polydipsia
List 6 triggers for DKA
infection
antipsychotics
myocardial infarction
chemotherapy
surgery
wrong insulin dose/ non-compliance
List the criteria for diagnosing DKA
- Blood glucose >11.0mmol/L or known diabetes mellitus
- Acidaemia (venous blood pH <7.3)
- Serum bicarbonate <15mmol/L
- Ketonuria (++ or above) or ketonaemia (>= 3.0mmol/L)
When should the patient be transferred to ICU for central venous access and monitoring?
If any of these occur:
- Blood ketones >6
- Venous bicarbonate <5
- Venous/ arterial pH <7
- K <3.5 on admission
- GCS <12
- O2 <92% on air
- Systolic BP <90
- Pulse >100 or <60
- Anion gap above 16
True or false: In DKA, plasma glucose is always high
false
True or false: High WCC always means infection
false
True or false: Infection always presents with fever in DKA
false
Why does plasma creatinine in DKA not represent true renal function?
Some assays for creatinine cross-react with ketone bodies so do not reflect true renal function
True or false: MSU, blood cultures and CXR are not necessary in DKA
false, they are necessary if suspect infection: common trigger
True or false? If sodium is within range, that means that the patient does not have severe water loss
False
Normal or high Na+ indicates severe water loss
Ketonuria does not always equate with ketoacidosis
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
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
True
True or false? Serum amylase can be raised up to 10x in DKA in the absence of DKA
True
What percentage saline should be given initially in DKA, how much and for how long?
0.9%
1L
1hour
Venous or arterial blood gas should be used initially for DKA?
venous blood gas
True or false: In DKA a catheter should be considered in patients who have not passed urine in 1 hour since commencing treatment
true
In DKA, at what point should you start 10% glucose infusion?
<14mmol/L plasma glucose
In DKA, you should continue fixed-rate insulin infusion until ketones, bicarb and pH reach what level?
Ketones <0.6mmol/L
Venous pH >7.3
Venous bicarb >15mmol/L
True or false: you should continue infusing insulin in DKA until urinary ketones are no longer testing positive
false
These can stay positive even after the DKA is resolved
True or false: it is important to find and treat the cause of DKA?
True
