Diabetic Ketoacidosis Flashcards
what causes diabetic ketoacidosis?
- uncontrolled lipolysis (not proteolysis)
- excess of free fatty acids
- converted ketone bodies
what are the most common precipitating factors of diabetic ketoacidosis?
- infection
- missed insulin doses
- MI
what are the features of diabetic ketoacidosis?
- abdominal pain
- polyuria, polydipsia, dehydration
- kussmaul respiration
- acetone-smelling breath
what is kussmaul respiration?
deep hyperventilation
what are the key diagnostic criteria for diabetic ketoacidosis?
- glucose >11 mmol/l
- pH < 7.3
- bicarbonate < 15 mmol/l
- ketones >3 mmol/l
- urine ketones +++
on average, how much fluid do patients with DKA deplete?
5-8 litres
what fluid replacement is given to patients with DKA?
isotonic saline
what rate should insulin be replaced in diabetic ketoacidosis?
0.1 unit/kg/hour
how does management change once blood glucose is <14 mmol/l?
10% dextrose at 125mls/hr
+
o.9% sodium chloride
how is insulin given in acute management of diabetic ketoacidosis?
fixed rate IV insulin infusion (0.1 unit/kg/hr) AND continue injectable long acting insulin
stop short acting insulin
what is DKA resolution defined as?
- pH >7.3
- blood ketones < 0.6 mmol/l
- bicarbonate > 15 mmol/l
when should the ketonaemia and acidosis be resolved in DKA?
within 24 hours
what are the complications from DKA?
- gastric stasis
- thromboembolism
- arrhythmias secondary to hyperkalaemia/iatrogenic hypokalaemia
- iatrogen due to incorrect fluid therapu - e.g. cerebral oedema, hypokalaemia, hypoglycaemia
- acute respiratory distress syndrome
- AKI
when does cerebral oedema typically present in DKA?
4-12 hours following commencement of treatment
what patients are particuarly at risk of developing cerebral oedema following DKA?
children/young adults
