Diabetic Ketoacidosis Flashcards
In what population does DKA arise?
T1DM
In DKA there is insulin -___ with ___ counter regulatory hormone
In DKA there is insulin -Deficiecny with increased counter regulatory hormone
How does pseudohyponatraemia arise in DKA?
Hyperglycaemia induces osmotic diuresis
How does glycosuria and ketonuria arise?
glucose and ketones exceed the renal threshold
Compare the changes between total body and serum K+
Total body is depleted
Serum K+ is normal/elevated
Why does K+ shift from ICF to ECF
Increased plasma osmolaltiy
What happens to total body PO4?
Depleted
What are the clinical features of DKA that start with P
Polyuria, Polyphagia, polydipsia
What can cause decreased level of consciousness in DKA?
Hyperglycaemia or dehydration
What are the GI symptoms of DKA?
Abdominal pain
Fruity breath
How does respiration change in DKA
Initially = Hyperventilation Late = Kussmaul's breathing
What do ABGs show for DKA
HAGMA with respiratory alkalosis
Key features of DKA on EUC
Increased BGL
Increased ketones
Decreased PO4
Should you use Arterial gas, BGL or serum ketones for monitoring ketoacidosis?
Arterial gases
What saline for rehydration?
0.9% NaCl
When do you implement Dextrose?
When the BGL has reduced to <14mmol/L
What is critical to resolve acidosis?
Insulin therapy
How should insulin be administered?
IV 3.3mmol/L Insulin
When do you administer HCO3-
If pH <7.0 or pH <7.1 + Arrhythmia or coma
What is the prognosis of DKA?
2-5% mortality
What is most likely to kill someone with DKA? (5)
Sepsis, hypokalaemia, respiratory complication, TE complication or cerebral oedema
What are the 4 principles of managing DKA?
Fluids
Insulin
Potassium
Treat precipitant
Name the 5 Is precipitating DKA
Infection Ischaemia Iatrogenic (glucocorticoids) Intoxication Insulin missed Initial presentation
In who does HHS typically arise?
T2DM
What is HHS often precipitated by?
Vascular: Stroke/MI Infection: Sepsis Trauma: Trauma, burns Metabolic: Renal Iatrogenic: glucocorticoids, immunosuppressants, diureeics Degenerative: CHF
Pathophys behind HHS?
Increased SNS with decreased Insulin prevents glucose into muscles –> leads to increased omsolality and hyperglycaemia –> dehydration
Is the dehydration more severe in DKA or HHS?
HHS - due to more gradual onset
How does coma arise in HHS?
High osmolality causes a shift in fluid from the Intra-celluar neutrons to the ECF
How does HHS present?
insipid onset of weakness, polyuria, polydipsia
What are key history components for DKA?
Preicpiating events
Reduced fluid intake
Why does Ketosis not arise in HHS?
Due to partial insulin presence
Is kussmaul’s breathing present in HHS?
No - As no acidosis
What dos the serum osmolality for HHS illustrate?
BGL +++ (>50mmol/L)
Dehydration and increased osmolality
Whereas glucose is ____ in the urine in HHS, ketones are ___ in the urin
Whereas glucose is present in the urine in HHS, ketones are absent in the urine
What are the principles of treatment of HHS
Same as DKA- Fluid, K+ replacement, treat precipitating event
Should insulin be applied in HHS?
No
What is the mortality for HHS?
approaches 50%
Which population is HHS most common in?
Elderly
