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Year3 Endo Conditions > Diabetic Ketoacidosis > Flashcards

Diabetic Ketoacidosis Flashcards

1
Q

What Diabetic ketoacidosis?

A

triad of hyperglycaemia (or a history of diabetes), ketonaemia, and metabolic acidosis, with rapid symptom onset

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2
Q

What are 3 parameters for diabetic ketoacidosis?

A
  1. Acidaemia pH <7.3
  2. Hyperglycaemia >11.0mmol/L
  3. Ketonaemia >3.0mmol/L or significant ketonuria (more than 2+ on dipstick)
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3
Q

What are RF for diabetic ketoacidosis?

A
  1. Infection
  2. Discontinuation or inadequate insulin therapy
  3. MI
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4
Q

What are symptoms and signs of DKA?

A
  1. Increased thirst
  2. Polyuria
  3. Weight loss
  4. Excessive tiredness
  5. Nausea
  6. Vomiting
  7. Dehydration
  8. Abdominal pain
  9. Reduced consciousness
  10. Hyperventilation
  11. Acetone smell on breath
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5
Q

What are possible DDx for DKA?

A
  1. Hyperosmolar hyperglycaemia state (HHS)
  2. Lactic acidosis
  3. Starvation ketosis
  4. Alcoholic ketoacidosis
  5. Salicylate poisoning
  6. Methanol intoxication
  7. Uraemic acidosis
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6
Q

What investigations are used for DKA?

A
  1. Venous blood gas
  2. Blood ketones
  3. Blood glucose
  4. U+Es
  5. FBC
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7
Q

What does venous blood gas show in DKA?

A

metabolic acidosis with raised anion gap (>16 severe)

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8
Q

What is blood ketones like in DKA?

A

ketonaemia (ketones >3.0 mmol/L)

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9
Q

What is blood glucose like in DKA?

A

hyperglycaemia (blood glucose >11.0 mmol/L) (but could be normal)

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10
Q

What are U+Es like in DKA?

A

hyponatraemia and hyperkalaemia are common but hypokalaemia is an indicator of severe DKA

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11
Q

What can FBC show in DKA?

A

leukocytosis

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12
Q

What is management plan for DKA?

A
  1. Fluids started (normal saline) + KCL (if K+<5.5)
  2. Iv insulin after fluids only when K+ not <3.5 – fixed rate insulin infusion
  3. Include dextrose in fluid if it falls <14
  4. Treat underlying cause e.g. Abx
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13
Q

What are possible complications of DKA?

A
  1. Hypokalaemia
  2. Hypoglycaemia
  3. Arterial or venous thromboembolic events
  4. Cerebral oedema/brain injury
  5. Pulmonary oedema/ARDS
  6. Non-anion gap hyperchloremic acidosis
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14
Q

What are mortality rates like for DKA?

A

have fallen significantly in the last 20 years from 7.96% to 0.67%

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15
Q

What are key symptoms of DKA?

A
  1. Kussmaul breathing (deep hyperventilation)
  2. Sweet smelling breath
  3. Abdominal pain
  4. N and V
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16
Q

What diabetes is DKA more common in?

17
Q

What is given to protect heart in hyperkal?

A

Calcium gluconate given for hyperkalaemia to protect heart (have hypo in these)

18
Q

What is pH in DKA?

Year3 Endo Conditions (33 decks)

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