Diabetic Ketoacidosis

Question 1

Definition of DKA?

Answer 1

From poorly managed T1DM or from infection/illness
Complete lack of insulin in high ketone production
Complication of T1DM- medical emergency

Question 2

What does a typical patient look like?

Answer 2

10 y/o presents to A&E with severe dehydration + history of T1DM

Question 3

Aetiology of DKA? (Cause)

Answer 3

Untreated/undiagnosed T1DM
Infection/illness

Question 4

What is the pathology of DKA?

Answer 4

Absolute insulin deficiency = uncontrolled catabolism = unrestrained lipolysis + gluconeogenesis & decreased peripheral glucose uptake - hyperglycemia

Hyperglycemia - osmotic diuresis - dehydration

So much gluconeogenesis-not all glucose stable therefore converted to ketone bodies (acidic = increased conc = keto acidosis)

Question 5

Signs and symptoms of DKA?

Answer 5

T1DM

Kussmaul’s breathing (deep, fast, constant labour Ed breaths, to blow off CO2 (acidic) ; compensation)

Pear drop breath (fruity ketone breath smell

Reduced tissue turgar - hypotension (osmotic diuresis) + tachycardia (kussmauls breathing)

Question 6

What investigations would you do to diagnose DKA?

Answer 6

Plasma ketones (blood) = >3mmol/L

RPG (hyperglycemia) = >11.1 mmol/L

Acidosis - blood pH = <7.35 or bicarb (HCO3-) = <15mmol/L

Urine dipstick = glycosuria and ketonuria
Serum U&E = raised urea and creatine
Hyperkalemia (serum increased, total decreased)

Question 7

What treatment would you give someone with DKA?

Answer 7

1. ABCDE (emergency)
2. 1st line always fluid - replace fluid : 0.9% saline IV - most patients die from dehydration first
3. Then IV insulin (+ glucose to prevent hypoglycemia)
4. Restores electrolytes (K+ , replenish K+ stores)