Diabetic Ketoacidosis Flashcards
To learn about DKA
How is DKA characterised?
A biochemical Triad of
- Hyperglycemia
- Ketoanaemia
- Acidaemia with rapid symptom onset
What are the common symptoms of DKA?
- Polyuria
- Polydipsia
- Polyphagia
- Weakness
- Weight loss
- Tachycardia
- Dry mucous membranes
- Poor skin turgor
- Hypotension
- Shock
What is the treatment for DKA?
- Correction of volume depletion
- Correction of hyperglycemia
- Correction of electrolyte balance
- Correction of comorbidities
- Frequent monitoring
What are the complications of DKA?
- Hypoglycemia
- Hypokalaemia
- Hypoxaemia
- Pulmonary Oedema
Cerebral Oedema is rare but potentially rapidly fatal complications. Mainly in children. Avoided by slow fluid and electrolyte replacement
What is DKA caused by?
Characterised by absolute insulin deficiency and is the most common hyperglycaemic complication of diabetes.
What are other hyperglycaemic states?
- Diabetes mellitus
- Non ketonic hyperosmolar coma
- Impaired glucose tolerance
- Stress hypoglycaemia
What are other ketotic states?
- Ketotic hypoglycemia
- Alcoholic ketosis
- Starvation ketosis
What are other metabolic acidotic States?
- Lactic acidosis
- Hyper chloraemic acidosis
- Salicylism
- Uraemic acidosis
- Drug induced acidosis
What are the precipitating factors for DKA?
- Omission of insulin
- Infections, sepsis
- Acute medical illness MI, Stroke,MI
- Stress of recent surgical procedures
- Psychological problems
- Insulin pump malfunctions
- Medications, diuretics, beta blockers, corticosteroids, antipsychotics, anticonvuksants
- In prepubertal girls 2/3 days before menses
What are the risk factors for DKA?
- Younger age (<2yr)
- Delayed diagnosis
- Lower socioeconomic status
- Countries with low prevalence of T1DM
In DKA what does insulin deficiency and high counter regulatory hormone concentrations leads to?
- Hyperglycemia
2. Increased lipolysis and ketogenesis
What is hyperglycemia caused by?
- An accelerated catabolic state, resulting in increased glucose production by the liver and kidney through glycogenolysis and gluconeogenesis.
- Impaired peripheral glucose use, occurs at the same time giving hyperglycemia and hyperosmolality.
How does increased lipolysis and ketogenesis cause ketonemia and metabolic acidosis in DKA?
- XS breakdown of adipose stores giving increased levels of free fatty acids
- Oxidation of such free fatty acids by the liver through acetyl CoA produce ketone bodies
3 Rate at which ketone bodies formed may exceed their use. - Ketogenesis leads to ketanaemia and ketonuria
- If urinary excretion affected by dehydration, plasma H+ ion conc inc, then systemic ketoacidosis results
What does hyperglycemia and nausea/vomiting associated with with severe ketosis lead to?
- Osmotic diuresis
- Severe fluid depression
- Life threatening electrolyte imbalance
What are the key values for water and electrolytes per kg of body weight on DKA
- H20=100mL/kg. (200)
- Na. = 7-10mEq/L (135-145)
- K = 3-5mEq/kg (3.5-5.1)
- Cl = 3-5mmol/kg (285-295)
- Ph. = 1mmol/kg (0.8-1.5)
How does serum glucose help to show DKA?
Usually > 13.9mmol/L
What are the values in ABG measurement that help to determine DKA
pH between 7-7.3
What are the serum electrolytes in DKA
- Bicarb level <18mmol/L
- Serum sodium level usually low
- Serum potassium is low/normal/elevated
- Magnesium usually low but can be normal
How are blood urea/nitrogen and creatinine levels affected in DKA
Usually elevated due to dehydration and decreased renal perfusion
How does serum ketone levels help in the investigations of DKA?
Confirms presence of glucose and ketones
How is the serum osmolality affected?
- > 320 mmol/kg
2. plasma osmolality = 2
What is the diagnostic criteria for DKA?
- Ketonaemia 3mmol/L
- Blood glucose >11mmol/L or knowm DM
- Venous bicarb (HCO3) below 15mmol/L
What is the management of DKA?
- Correction of dehydration
- Correction of acidosis and reverse ketosis
- Restoration of blood glucose to near normal levels
- Monitor for. complications of DKA
- Identify and treat precipitating events
In DKA what are the complications of hypokalaemia and hyperkalaemia
- K should not be Px with initial fluid if it remains above 5.5 mmol/L
- Treatment with insulin always leads to a fall in K
- 0.9% Na Cl soln with K 40mmol/L given if K below 5.5mmol/L
What are the complications of DKA?
- Hypoglycemia
- Cerebral Oedema
- Pulmonary Oedema in the old with impaired cardiac function
