Diabetic Ketoacidosis

Question 1

What is diabetic ketoacidosis a complication of?

Answer 1

Type 1 DM

or can be the first presentation

Question 2

What is a DKA due to?

Answer 2

uncontrolled lipolysis resulting in an excess of free fatty acids that are converted to ketone bodies

Question 3

What does uncontrolled lipolysis subsequently lead to?

Answer 3

An excess of free fatty acids being converted into ketone bodies

Question 4

What are the most common precipitating factors of a DKA?

Answer 4

Infection
Missed insulin doses
Myocardial infarction
Dehydration
Fasting

Question 5

What type of situation is a DKA?

Answer 5

Medical emergency

Question 6

What are the main presenting features of a DKA?

Answer 6

Vomiting
Dehydration
Abdominal pain
Acetone smelling breath
Kussmaul respiration

Question 7

What is kussmaul respiration?

Answer 7

Deep hyperventilation

Question 8

What three things are used in the diagnosis of diabetic ketoacidosis?

Answer 8

Hyperglycaemia
Ketonaemia
Acidosis

Question 9

What level of ketonaemia suggests a diagnosis of DKA?

Answer 9

3mmol/L and over

urine ketones ++ on dipstick

Question 10

What blood glucose measurement would suggest a diagnosis of DKA?

Answer 10

Over 11mmol/L

Question 11

What would suggests acidosis in someone presenting with a DKA?

Answer 11

Bicarbonate <15mmol/L
pH < 7.3

Question 12

What is the initial management of someone presenting with a DKA?

Answer 12

Fluid replacement

0.9% saline

Question 13

What should be started after the 0.9% saline in someone presenting with a DKA?

Answer 13

IV insulin infusion at 0.1 unit/kg/hour

Question 14

Once the blood glucose is < 14 mmol/l, what should be administered?

Answer 14

Infusion of 10% dextrose should be started at 125 mls/hr

Question 15

What electrolyte disturbance usually occurs during a DKA?

Answer 15

Hyerkalaemia on admission
This falls when insulin administered

Question 16

How is the hypokalaemia managed in someone with a DKA?

Answer 16

Add potassium to maintenance fluids

Question 17

What form of insulin should be continued when someone is having a DKA?

Answer 17

Long acting insulin hsould be continued

Question 18

What form of insulin should be stopped when someone is having a DKA?

Answer 18

Short acting insulin

Question 19

What measurements would suggest that the DKA has resolved?

Answer 19

pH >7.3
blood ketones < 0.6 mmol/L
bicarbonate > 15.0mmol/L

Question 20

What complication of a DKA are young people particularly vulnerable to?

Answer 20

Cerebral oedema due to fluid resuscitation

Question 20

What complication of a DKA are young people particularly vulnerable to?

Answer 20

Cerebral oedema due to fluid resuscitation