Diabetic Ketoacidosis

Question 1

Pathogenesis of DKA

Answer 1

↓ Insulin:
Ketogenesis
Dehydration
Acidosis

Question 2

Ketogenesis in DKA

Answer 2

↓ Insulin
↑ fatty acids
→ ↑ ATP + generation of ketone bodies

Question 3

Dehydration in DKA

Answer 3

↓ Insulin
↑ GNG
Osmotic diuresis → dehydration
Also, ↑ ketones → vomiting

Question 4

Acidosis in DKA

Answer 4

Dehydration → ↓ renal perfusion

Hyperkalaemia

Question 5

Precipitants of DKA

Answer 5

Infection / stress
+/- Stopping insulin
New T1DM

Question 6

Presentation of DKA

Answer 6

Abdo pain
Vomiting
Gradual drowsiness
Sighing "Kussmaul" hyperventilation 
Dehydration
Ketotic breath

Question 7

Diagnosis of DKA

Answer 7

Acidosis
Hyperglycaemia > 11 mM (or known DM)
Ketonaemia > 3 mM (> 2 on dipstick)

Question 8

Ix for DKA

Answer 8

Urine - ketones + glucose
Cap - ketones + glucose
VBG - acidosis, ↑K
Bloods
CXR - ?infection
Amylase often raised

Question 9

Complications of DKA

Answer 9

Cerebral oedema - excess fluid administration
Aspiration pneumonia
Hypokalaemia
Hypophosphataemia - resp + skeletal muscle weakness
Thromboembolism

Question 10

Mx of DKA

Answer 10

GRIP

Gastric aspiration
Rehydrate
Insulin infusion
Potassium replacement

Remove ketones

Question 11

Insulin infusion for DKA dose

Answer 11

Actrapid
0.1 u/kg/hr IV
6u if no wt
Max 15u

Question 12

Resolution of DKA

Answer 12

Ketones < 0.3 mM + venous pH > 7.3