Diabetic ketoacidosis

Question 1

How do most patients in DKA die?

Answer 1

Hypovolemic shock

NOT arrhythmia – though they are also at risk for arrhythmias

Question 2

Big picture steps to resolve DKA

Answer 2

1. Volume resuscitation
2. Calcium gluconate if hyperkalemic or EKG changes
3. Begin administering IV insulin with frequent electrolyte checks and potassium / dextrose as needed
4. Once glucose is normalized, discontinue IV insulin and give subcutaneous insulin with 2 hr overlap

Question 3

Criteria for DKA

Answer 3

1. Blood glucose > 250 mg/dL
2. pH < 7.30 or bicarbonate < 20 mmol/L
3. Detection of plasma ketones

Question 4

Treatment of anion gap vs non-anion gap metabolic acidosis

Answer 4

Anion gap: Correct the underlying condition

Non-anion gap: Replete the HCO3 loss