DIABETIC KETOACIDOSIS

Question 1

These are all indicative of what condition?

1. Hyperglycemia >250mg/dL
2. Acidosis with blood pH less than or equal too 7.3
3. Serum bicarbonate less than or equal to 15mEq/L
4. Serum positive for ketones

Answer 1

DKA

Question 2

What may be the initial manifestation of both type 1 or type 2 diabetes and commonly occurs with poor compliance in type 1 diabetes, particularly when episodes are recurrent?

Answer 2

Diabetic Ketoacidosis

Question 3

What develops in type 1 and type 2 diabetes with increased insulin requirements during infection, trauma, myocardial infarction or surgery?

Answer 3

Diabetic ketoacidosis

Question 4

What may develop in type 2 diabetes under severe stress such as sepsis or trauma and is a common serious complication of insulin pump therapy?

Answer 4

Diabetic ketoacidosis

Question 5

What can present with the clinical findings below?

1. may begin with a day or more of polyuria, polydipsia, marked fatigue, nausea and vomiting and, finally mental stupor that can progress to coma
2. dehydration, possible stupor
3. rapid deep breathing and a “fruity” breath odor of acetone
4. Hypotension w/ tachycardia indicated profound fluid and electrolyte depletion
5. mild hypothermia usually present, elevated or even a normal temp may suggest infection
6. abdominal pain and tenderness in the absence of abdominal disease; conversely cholecystitis or pancreatitis may occur with minimal symptoms and signs

Answer 5

DKA

Question 6

What is the initial management therapy for DKA?

Answer 6

Volume repletion

Question 7

What is the fluid of choice in the volume repletion of DKA treatment?

Answer 7

lactated ringers

Question 8

When glucose falls to ____ or less, use 5% glucose solutions to maintain blood glucose 200-300mg/dL while continuing insulin to clear serum ketones.

Answer 8

250mg/dL

Question 9

Once improvement is noted in vitals and hyperglycemia and adequate urine output of at least ____ is ensured, iv fluids may be reduced to maintenance levels or discontinued if the patient is taking oral fluids well.

Answer 9

30-50mL/h

Question 10

True or False
The cornerstone of therapy for acute hyperglycemia is restoration of intravascular volume and reperfusion of vital organs, especially the kidneys

Answer 10

True

Question 11

Often potassium is elevated initially due to metabolic acidosis, however correction of acidosis and insulin-mediated transfer of potassium into the cells may cause what?

Answer 11

serum potassium rapidly falling and may require aggressive repletion

Question 12

Fluid over load for the treatment of DKA needs to be avoided in patients with what?

Answer 12

Cardiac disease

Question 13

Excessive fluid replacement (more than 5 L in 8 H) may contribute to what?

Answer 13

1. respiratory distress syndrome

2. cerebral edema

Question 14

True or False

Initially insulin plus fluid and electrolyte replacement is the mainstay of treatment for DKA

Answer 14

True

consult medical officer prior to insulin administration

Question 15

What is the inital loading dose of insulin, followed by 0.1 unit/kg/h, continuously infused or given hourly as an SUBQ injection for the treatment of DKA?

Answer 15

0.15 unit/kg IV bolus

Question 16

True or False

If plasma glucose level fails to falls at least 10% in the first hour, give repeat loading dose

Answer 16

True

Question 17

What is the disposition for a patient in DKA?

Answer 17

GET OUT ME SWAMP

Question 18

Those listed below are complications associated with what condition?

1. AMI and infarction of the bowel following prolonged hypotension
2. Renal failure, especially with prior kidney dysfunction
3. Cerebral edema occurs rarely
   a. best prevented by avoiding sudden reversal of hyperglycemia
   b. maintaining glycemic levels of 200-300mg/dL for the initial 24 h after correction of severe hyperglycemia reduces this risk

Answer 18

DKA