Diabetic Ketoacidosis

Question 1

In what population does DKA arise?

Answer 1

T1DM

Question 2

In DKA there is insulin -___ with ___ counter regulatory hormone

Answer 2

In DKA there is insulin -Deficiecny with increased counter regulatory hormone

Question 3

How does pseudohyponatraemia arise in DKA?

Answer 3

Hyperglycaemia induces osmotic diuresis

Question 4

How does glycosuria and ketonuria arise?

Answer 4

glucose and ketones exceed the renal threshold

Question 5

Compare the changes between total body and serum K+

Answer 5

Total body is depleted

Serum K+ is normal/elevated

Question 6

Why does K+ shift from ICF to ECF

Answer 6

Increased plasma osmolaltiy

Question 7

What happens to total body PO4?

Answer 7

Depleted

Question 8

What are the clinical features of DKA that start with P

Answer 8

Polyuria, Polyphagia, polydipsia

Question 9

What can cause decreased level of consciousness in DKA?

Answer 9

Hyperglycaemia or dehydration

Question 10

What are the GI symptoms of DKA?

Answer 10

Abdominal pain

Fruity breath

Question 11

How does respiration change in DKA

Answer 11

Initially = Hyperventilation
Late = Kussmaul's breathing

Question 12

What do ABGs show for DKA

Answer 12

HAGMA with respiratory alkalosis

Question 13

Key features of DKA on EUC

Answer 13

Increased BGL
Increased ketones
Decreased PO4

Question 14

Should you use Arterial gas, BGL or serum ketones for monitoring ketoacidosis?

Answer 14

Arterial gases

Question 15

What saline for rehydration?

Answer 15

0.9% NaCl

Question 16

When do you implement Dextrose?

Answer 16

When the BGL has reduced to <14mmol/L

Question 17

What is critical to resolve acidosis?

Answer 17

Insulin therapy

Question 18

How should insulin be administered?

Answer 18

IV 3.3mmol/L Insulin

Question 19

When do you administer HCO3-

Answer 19

If pH <7.0 or pH <7.1 + Arrhythmia or coma

Question 20

What is the prognosis of DKA?

Answer 20

2-5% mortality

Question 21

What is most likely to kill someone with DKA? (5)

Answer 21

Sepsis, hypokalaemia, respiratory complication, TE complication or cerebral oedema

Question 22

What are the 4 principles of managing DKA?

Answer 22

Fluids
Insulin
Potassium
Treat precipitant

Question 23

Name the 5 Is precipitating DKA

Answer 23

Infection
Ischaemia
Iatrogenic (glucocorticoids)
Intoxication
Insulin missed
Initial presentation

Question 24

In who does HHS typically arise?

Answer 24

T2DM

Question 25

What is HHS often precipitated by?

Answer 25

Vascular: Stroke/MI
Infection: Sepsis
Trauma: Trauma, burns
Metabolic: Renal
Iatrogenic: glucocorticoids, immunosuppressants, diureeics
Degenerative: CHF

Question 26

Pathophys behind HHS?

Answer 26

Increased SNS with decreased Insulin prevents glucose into muscles –> leads to increased omsolality and hyperglycaemia –> dehydration

Question 27

Is the dehydration more severe in DKA or HHS?

Answer 27

HHS - due to more gradual onset

Question 28

How does coma arise in HHS?

Answer 28

High osmolality causes a shift in fluid from the Intra-celluar neutrons to the ECF

Question 29

How does HHS present?

Answer 29

insipid onset of weakness, polyuria, polydipsia

Question 30

What are key history components for DKA?

Answer 30

Preicpiating events

Reduced fluid intake

Question 31

Why does Ketosis not arise in HHS?

Answer 31

Due to partial insulin presence

Question 32

Is kussmaul’s breathing present in HHS?

Answer 32

No - As no acidosis

Question 33

What dos the serum osmolality for HHS illustrate?

Answer 33

BGL +++ (>50mmol/L)

Dehydration and increased osmolality

Question 34

Whereas glucose is ____ in the urine in HHS, ketones are ___ in the urin

Answer 34

Whereas glucose is present in the urine in HHS, ketones are absent in the urine

Question 35

What are the principles of treatment of HHS

Answer 35

Same as DKA- Fluid, K+ replacement, treat precipitating event

Question 36

Should insulin be applied in HHS?

Answer 36

No

Question 37

What is the mortality for HHS?

Answer 37

approaches 50%

Question 38

Which population is HHS most common in?

Answer 38

Elderly