Diabetic ketoacidosis Flashcards
DKA triad
- Ketosis - >3mmol/L
- Hyperglycaemia - >11 mmol/L
- Acidaemia - <7.3
DKA triggers
- Infection - flu/UTI
- Poor compliance with tx - missing insulin dose - dangerous in children
- Injury/surgery
- Drugs like steroids
- Binge drinking
- Illegal drugs
- Pregnancy
- Menstruation
Fluid and electrolyte shifts in DKA
Absent insulin Hyperglycaemia Glycosuria Osmoticd diuresis - electrolyte loss of Na+ and K+ and Cl- Dehydration = renal failure
How does diabetes make you dehydrated?
Glucose in urine recalls water into drainage system
Insulin MOA
After eating, pancreas senses and starts secreting hormones
Insulin binds to receptor
opens up GLUT4 which allows glucose to move into cells
What happens to cause DKA
No glucose Brain uses triglycerides instead triglycerides -> FFA anf glycerol FFA converted to acetyl cox by B oxidation Kreb's cycle is saturated aCOA converted to ketones Ketones dissociate H+ in blood
Normal anion gap
12 - raised indicated ketoacidosis
MUDPILES
methanol/ethanol intoxication, uremia, DKA, paracetamol overdose, ischaemia, lactate, ethylene glycol intoxication (anti-freeze), salicylate
For diagnosing DKA
If you suspect overdose, send blood samples for..
Methanol, paracetamol, ethylene glycol, salicylate
When will uraemia be present?
AKI
Acetoacetate
First ketone made, created from FFA breakdown, can be used directly or converted to BHB
Used to measure from urine samples
BHB
Most prevalent and energy efficient, produced in cardboard restriction
Acetone
Virtually useless, excreted through breath
Kussmaul breathing
Deep and laboured breathing with tachypnoea in attempt to decrease PaCo2
Treating DKA
Saline infusion
Monitor potassium - should be between 4 and 5.5
Initially give fixed rate insulin and then variable
