Diabetic Ketoacidosis

Question 1

Essentials of diagnosis for what issue?

(1) Hyperglycemia > 250 mg/dL
(2) Acidosis with blood pH < 7.3
(3) Serum bicarbonate < 15 mEq/L
(4) Serum positive for ketones

Answer 1

Diabetic Ketoacidosis

Question 2

True/False

Diabetic Ketoacidosis may be the initial manifestation of both type 1 or type 2 diabetes.

Answer 2

True

Question 3

Commonly occurs with ________ in type 1 diabetics, particularly when episodes are recurrent

Answer 3

poor compliance

Question 4

Clinical Findings for what issue?

(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 with tachycardia indicates profound fluid and electrolyte depletion.
(5) Mild hypothermia usually present; elevated or even a normal temperature 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 4

Diabetic KETO

Question 5

Diabetic KETO may develop in type 2 diabetics under severe stress such as

Answer 5

sepsis or trauma

Question 6

The cornerstone of therapy for acute hyperglycemia is what?

Answer 6

Restoration of intravascular volume and reperfusion of vital organs, especially the kidneys.

Question 7

1) Volume repletion is the _____ management priority.
2) Fluid deficit is usually 4-5 L. In the first hour,
3) give at ___ L of 0.9% normal saline to re-expand contracted vascular volume

Answer 7

1) Initial

3) at least 1 L

Question 8

When providing volume repletion for a DKA pt, what is the fluid of choice if available?

Answer 8

Lactated ringers

Question 9

Be careful to avoid fluid overload in patients with cardiac disease.
-Excessive fluid replacement of more than 5 L in 8 h, may contribute to what?

Answer 9

acute respiratory distress syndrome or cerebral edema

Question 10

What is the mainstay of tx for DKA

Answer 10

Initially Insulin plus fluid and electrolyte replacement

-Consult Medical Officer prior to Insulin Administration

Question 11

True/False

Consult Medical Officer prior to Insulin Administration of insulin

Answer 11

True

Question 12

Insulin TX for DKA

1. Begin with loading dose of ____ unit/kg as IV bolus, followed by ____ unit/kg/h, continuously infused or given hourly as an IM injection
2. Recheck _______ before repeat insulin injection(s).
3. ________ insulin into the fluid line so the rate of fluid replacement can be changed without altering the insulin delivery rate
4. If plasma glucose level fails to fall at least ___% in the first hour, give repeat loading dose

Answer 12

1. 0.15 unit/kg IV followed by 0.1 unit/kg/h IM
2. blood glucose
3. “Piggy-back”
4. 10%

Question 13

Disposition of DKA

Answer 13

MEDIVAC