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Electrolytes > Diabetic Ketoacidosis > Flashcards

Diabetic Ketoacidosis Flashcards

To learn about DKA

1
Q

How is DKA characterised?

A

A biochemical Triad of

  1. Hyperglycemia
  2. Ketoanaemia
  3. Acidaemia with rapid symptom onset
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2
Q

What are the common symptoms of DKA?

A
  1. Polyuria
  2. Polydipsia
  3. Polyphagia
  4. Weakness
  5. Weight loss
  6. Tachycardia
  7. Dry mucous membranes
  8. Poor skin turgor
  9. Hypotension
  10. Shock
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3
Q

What is the treatment for DKA?

A
  1. Correction of volume depletion
  2. Correction of hyperglycemia
  3. Correction of electrolyte balance
  4. Correction of comorbidities
  5. Frequent monitoring
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4
Q

What are the complications of DKA?

A
  1. Hypoglycemia
  2. Hypokalaemia
  3. Hypoxaemia
  4. Pulmonary Oedema

Cerebral Oedema is rare but potentially rapidly fatal complications. Mainly in children. Avoided by slow fluid and electrolyte replacement

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5
Q

What is DKA caused by?

A

Characterised by absolute insulin deficiency and is the most common hyperglycaemic complication of diabetes.

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6
Q

What are other hyperglycaemic states?

A
  1. Diabetes mellitus
  2. Non ketonic hyperosmolar coma
  3. Impaired glucose tolerance
  4. Stress hypoglycaemia
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7
Q

What are other ketotic states?

A
  1. Ketotic hypoglycemia
  2. Alcoholic ketosis
  3. Starvation ketosis
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8
Q

What are other metabolic acidotic States?

A
  1. Lactic acidosis
  2. Hyper chloraemic acidosis
  3. Salicylism
  4. Uraemic acidosis
  5. Drug induced acidosis
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9
Q

What are the precipitating factors for DKA?

A
  1. Omission of insulin
  2. Infections, sepsis
  3. Acute medical illness MI, Stroke,MI
  4. Stress of recent surgical procedures
  5. Psychological problems
  6. Insulin pump malfunctions
  7. Medications, diuretics, beta blockers, corticosteroids, antipsychotics, anticonvuksants
  8. In prepubertal girls 2/3 days before menses
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10
Q

What are the risk factors for DKA?

A
  1. Younger age (<2yr)
  2. Delayed diagnosis
  3. Lower socioeconomic status
  4. Countries with low prevalence of T1DM
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11
Q

In DKA what does insulin deficiency and high counter regulatory hormone concentrations leads to?

A
  1. Hyperglycemia

2. Increased lipolysis and ketogenesis

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12
Q

What is hyperglycemia caused by?

A
  1. An accelerated catabolic state, resulting in increased glucose production by the liver and kidney through glycogenolysis and gluconeogenesis.
  2. Impaired peripheral glucose use, occurs at the same time giving hyperglycemia and hyperosmolality.
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13
Q

How does increased lipolysis and ketogenesis cause ketonemia and metabolic acidosis in DKA?

A
  1. XS breakdown of adipose stores giving increased levels of free fatty acids
  2. 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.
  3. Ketogenesis leads to ketanaemia and ketonuria
  4. If urinary excretion affected by dehydration, plasma H+ ion conc inc, then systemic ketoacidosis results
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14
Q

What does hyperglycemia and nausea/vomiting associated with with severe ketosis lead to?

A
  1. Osmotic diuresis
  2. Severe fluid depression
  3. Life threatening electrolyte imbalance
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15
Q

What are the key values for water and electrolytes per kg of body weight on DKA

A
  1. H20=100mL/kg. (200)
  2. Na. = 7-10mEq/L (135-145)
  3. K = 3-5mEq/kg (3.5-5.1)
  4. Cl = 3-5mmol/kg (285-295)
  5. Ph. = 1mmol/kg (0.8-1.5)
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16
Q

How does serum glucose help to show DKA?

A

Usually > 13.9mmol/L

17
Q

What are the values in ABG measurement that help to determine DKA

A

pH between 7-7.3

18
Q

What are the serum electrolytes in DKA

A
  1. Bicarb level <18mmol/L
  2. Serum sodium level usually low
  3. Serum potassium is low/normal/elevated
  4. Magnesium usually low but can be normal
19
Q

How are blood urea/nitrogen and creatinine levels affected in DKA

A

Usually elevated due to dehydration and decreased renal perfusion

20
Q

How does serum ketone levels help in the investigations of DKA?

A

Confirms presence of glucose and ketones

21
Q

How is the serum osmolality affected?

A
  1. > 320 mmol/kg

2. plasma osmolality = 2

22
Q

What is the diagnostic criteria for DKA?

A
  1. Ketonaemia 3mmol/L
  2. Blood glucose >11mmol/L or knowm DM
  3. Venous bicarb (HCO3) below 15mmol/L
23
Q

What is the management of DKA?

A
  1. Correction of dehydration
  2. Correction of acidosis and reverse ketosis
  3. Restoration of blood glucose to near normal levels
  4. Monitor for. complications of DKA
  5. Identify and treat precipitating events
24
Q

In DKA what are the complications of hypokalaemia and hyperkalaemia

A
  1. K should not be Px with initial fluid if it remains above 5.5 mmol/L
  2. Treatment with insulin always leads to a fall in K
  3. 0.9% Na Cl soln with K 40mmol/L given if K below 5.5mmol/L
25
Q

What are the complications of DKA?

A
  1. Hypoglycemia
  2. Cerebral Oedema
  3. Pulmonary Oedema in the old with impaired cardiac function

Electrolytes (5 decks)

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