Diabetic Ketoacidosis Flashcards
DKA is characterised by:
-Hyperglycaemia: blood glucose > 11.0mmol/L or known diabetes mellitus
-Ketonaemia: ketones > 3.0mmol/L or significant ketonuria (more than 2+ on standard urine sticks)
- Acidosis: bicarbonate (HCO3-) < 15.0mmol/L and/or venous pH < 7.3
DKA can be caused by either:
- Absolute insulin deficiency (e.g. type 1 diabetes)
- Complete insulin insensitivity (e.g. insulin-dependent type 2 diabetes)
Typical symptoms of DKA include:
Palpitations
Nausea
Vomiting
Sweating
Thirst
Weight loss
Leg cramps
Clinical signs
Typical clinical signs of DKA include:
Tachycardia
Hypotension
Reduced skin turgor
Dry mucous membranes
Reduced urine output
Altered consciousness (e.g. confusion, coma)
Kussmaul breathing
Clinical assessment signs of DKA (Respiratory)
Kussmaul breathing
Hypoxaemia may occur due to aspiration or bradypnoea in the context of severe DKA.
An arterial blood gas (ABG) can provide lots of useful information to guide management including:
PaO2: may be reduced in the context of pneumonia (e.g. DKA precipitated by a respiratory infection).
PaCO2: may be low in the context of DKA due to respiratory compensation as a result of metabolic acidosis.
pH: low in the context of DKA due to the presence of acidic ketones.
HCO3-: low in the context of DKA due to metabolic acidosis.
Clinical assessment signs of DKA (cardiac)
Tachycardia
Bradycardia is a late sign
Hypovolaemia
Blood tests
Collect blood tests after cannulating the patient including:
FBC: to screen for anaemia and signs of infection.
U&Es: to assess renal function and electrolyte levels (e.g. hyperkalaemia).
CRP: to screen for evidence of infection.
Serum glucose: to accurately measure the patient’s current serum glucose levels (point of care devices are often inaccurate in the context of very high glucose levels).
Liver function tests: to screen for liver abnormalities.
