Diabetic Ketoacidosis Flashcards
What is diabetic ketoacidosis (DKA) and in which population is it most commonly seen as an initial presentation?
DKA is a life-threatening medical emergency characterized by ketoacidosis, dehydration, and potassium imbalance. It is the most common way children with new diagnoses of type 1 diabetes present.
Explain the process of ketogenesis and how it differs in healthy individuals versus those with diabetic ketoacidosis.
Ketogenesis occurs when there is insufficient glucose, and the liver converts fatty acids into ketones for fuel. In healthy individuals, ketones are buffered and harmless, but in DKA, extreme hyperglycaemia leads to unbuffered ketones causing metabolic acidosis.
What are the three main pathophysiological problems in DKA?
The three main problems are:
1. Ketoacidosis: Caused by excessive production of ketones that leads to metabolic acidosis.
2. Dehydration: Due to osmotic diuresis caused by hyperglycaemia.
3. Potassium Imbalance: Insulin deficiency prevents potassium storage in cells, leading to total body potassium depletion.
Why does dehydration occur in diabetic ketoacidosis, and what are the clinical signs?
Dehydration occurs due to osmotic diuresis, where glucose in the urine pulls water with it. Clinical signs include polyuria, polydipsia, and hypotension.
Describe the relationship between insulin and potassium in diabetic ketoacidosis.
Insulin drives potassium into cells. In DKA, lack of insulin prevents potassium storage, leading to a high or normal serum potassium but low total body potassium. Upon insulin administration, serum potassium can drop rapidly, causing hypokalaemia and the risk of fatal arrhythmias.
What are the key priorities in the management of DKA?
The key priorities are:
- Fluid resuscitation to correct dehydration, electrolyte disturbances, and acidosis.
- Insulin infusion to allow glucose uptake and stop ketone production.
- Monitoring for potassium imbalance, preventing hypoglycaemia, and avoiding cerebral oedema.
Why are children with DKA at risk of cerebral oedema, and how should this be managed?
Rapid correction of dehydration and hyperglycaemia can cause a rapid water shift into brain cells, leading to cerebral oedema. Management includes slowing IV fluids, using IV mannitol or IV hypertonic saline, and frequent neurological monitoring.
What are the typical clinical features of DKA?
Clinical features include:
-Polyuria
-Polydipsia
-Nausea and vomiting
-Weight loss
-Acetone breath
-Dehydration and hypotension
-Altered consciousness
-Signs of underlying triggers (e.g., sepsis)
What criteria are used to diagnose DKA?
DKA is diagnosed based on the following criteria:
Hyperglycaemia: Blood glucose > 11 mmol/L
Ketosis: Blood ketones > 3 mmol/L
Acidosis: pH < 7.3
What are the two main pillars of DKA management in children?
The two main pillars are:
Correct dehydration slowly over 48 hours to prevent cerebral oedema.
Administer a fixed-rate insulin infusion to stop ketone production and allow glucose utilization.
Why is it important to avoid fluid boluses in DKA management, and when might they be used?
Fluid boluses increase the risk of cerebral oedema. They should only be used in cases of resuscitation.
How is hypoglycaemia prevented during DKA management?
Hypoglycaemia is prevented by adding IV dextrose to fluids once the blood glucose falls below 14 mmol/L.
What should be monitored closely during DKA treatment to assess the patient’s progress and determine when to switch to subcutaneous insulin?
Glucose, ketones, and pH levels should be closely monitored during treatment to guide the transition to subcutaneous insulin.
What are the common triggers for DKA, and how should they be managed?
Common triggers include infections such as sepsis. Management involves treating the underlying cause, for example, administering antibiotics for infections.
What management options are available for cerebral oedema in DKA?
Management options for cerebral oedema include:
- Slowing IV fluid administration
- IV mannitol
- IV hypertonic saline
- Close neurological monitoring
