Diabetic Ketoacidosis

Question 1

Ranges for DKA diagnosis with serum?

Answer 1

Hyperglycemia: 250 mg/dl
Acidosis: ph <7.3
serum bicarb: <15 mEq/L
Serum + for Ketones

Question 2

DKA is most commonly seen with _____

Answer 2

poor compliance with type 1 DM

Question 3

what are some things that could contribute to DKA with type 1 and type 2 DM?

Answer 3

increased insulin requirements during infection, trauma, MI, or surgery.

Question 4

clinical findings of DKA:

Answer 4

polyuria, polydipsia,
fatigue, N/V
mental stupor
rapid deep breaths
“fruity” breath of acetone
hypothermia
hypotension w tachy
abdominal pain with absence of abdominal disease

Question 5

Treatment for DKA:

Answer 5

start fluid replacement with IV (lactated ringers preferred)

when glucose falls to 250 or lower, use 5% glucose solutions and insulin. (maintain blood glucose @ 200-200 mg/dl)

may reduce IV therapy to maintenance level once improvement of sx and urine output is 30-50 mL/h

Question 6

What are some additional things you should monitor during fluid replacement for DKA?

Answer 6

electrolytes ( serum potassium may fall and require aggressive repletion)

excessive fluid replacement could also cause respiratory distress, cerebral edema. be cautions with patients with cardiac disease.

Question 7

how is insulin administered during IV DKA treatment?

Answer 7

“piggy-back” through IV line so rate of fluid replacement can be changed without altering the insulin delivery rate.

Question 8

In DKA, what is a way to reduce the risk of cerebral edema?

Answer 8

maintain serum glycemic levels between 200-300 for the initial 24 hrs.