Diabetic Ketoacidosis

Question 1

What is diabetic ketoacidosis?

Answer 1

• acute, severe, potentially life threatening complication of diabetes
• hyperglycemia
• dehydration
• ketoacidosis

Question 2

Which diabetics get DKA?

Answer 2

almost exclusively type 1

Question 3

What causes the hyperglycemia of DKA?

Answer 3

• insulin deficiency
• increased hepatic glucose production
• decreased glucose uptake by tissues
• marked glycosuria leads to osmotic diuresis and severe dehydration

Question 4

What causes the ketonemia of DKA?

Answer 4

• increased lipolysis –> increased VLDL and TG

- fatty acids diverted to ketogenic pathways in the liver

Question 5

What causes the acidosis of DKA?

Answer 5

• increased anion gap
• hepatic ketogenesis
• rise in ketoacids –> acidosis
• tissue hypoxia –> lactic acidosis (rare)

Question 6

Risk Factors for DKA

Answer 6

• type 1 DM
• interruption of insulin therapy
• insulin pump failure
• stress of an acute or chronic illness
• problems with compliance
• alcohol and drug addiction

Question 7

What are the 5 I’s that can cause DKA in type 1 DM patients?

Answer 7

• infection
• inflammation
• insulin deficient
• intoxication
• ischemia

Question 8

Symptoms of DKA

Answer 8

• N/V/A
• thirst
• polyuria
• weight loss
• weakness
• mental status changes

Question 9

Signs of DKA

Answer 9

• hyperventilation
• Kussmaul respirations w/ acetone breath
• dehydration
• warm, dry, flushed skin
• hypotension, postural dizziness
• tachycardia
• shock, CNS depression, coma

Question 10

DKA Lab Findings

Answer 10

• serum glucose > 250
• positive betahydroxybuterate
• positive urine and serum ketones
• arterial and venous pH < 7.3 (acidosis)
• bicarb < 15
• anion gap > 16

Question 11

DKA Treatment

Answer 11

• normal saline: rapid for first 2 liters then slower
• insulin: continuous IV infusion then titrate dose down once glucose <250
• restore acid-base balance with IV hydration and correction of electrolytes

Question 12

DKA Monitoring

Answer 12

• blood glucose q30-60 min then qhr
• electrolytes q2-4 hrs
• venous pH q2 hrs until pH > 7
• ketones in 24 hours
• I/O

Question 13

Complications of DKA

Answer 13

• hyperglycemia: CNS depression, coma, cerebral edema
• venous thrombosis
• acute resp distress syndrome
• UGI bleed
• pancreatitis

Question 14

DKA Prevention

Answer 14

• early type 1 diagnosis
• SBGM
• ketone monitoring
• patient education is key