Diabetic Ketoacidosis Flashcards
What is DKA?
insulin deficiency causing an increase in blood glucose
Is DKA more likely to occur in a Type 1 or Type 2 diabetic?
Type 1
How do ketone bodies form in the blood?
there in an increase in the counter regulatory hormones - glucagon, adrenaline, cortisol, GH - that cause the release of free fatty acids (through lipolysis
These free fatty acids are synthesised by the liver into ketone bodies
What are the biochemical signs that allow a diagnosis to be made?
ketonaemia >3 or ketonuria >2
blood glucose >11
bicarbonate >15
venous pH <7.3
What is the ABG picture of DKA?
metabolic acidosis
What are the peadiatric complications of DKA?
cerebral oedema
What are the adult complications of DKA?
hypokaleamia –> cardiac arrest
aspiration pneumonia
ARDS
acute kidney injury
What is the typical presentation of DKA?
thirst polyuria Kussmal's respiration deep, laboured breathlessness abdo pain vomiting acetone breath smell
What does Kussmal’s respiration represent?
body blowing off CO2
Why is potassium low in DKA?
insulin drives K into the cells, there is not enough insulin to do this in DKA so the K leaks out of the cell and causes hypokalaemia
How is DKA treated?
Commence IV 0.9% sodium chloride (saline)
replace potassium - give 40mmol/l infusion
Fixed rate Insulin Infusion (FRII) - 50 units of Actrapid with 0.9% NaCl
give sugar to avoid hypoglyceamia
What rate is Actrapid infused at?
0.1 unit/kg/hour
What investigations would you want to do for DKA?
Bloods - FBC, Us&Es, ABGs
Urinalysis
What are the 5 I causes of DKA?
Insulin Intercurrent illness Intoxication Infection Infarction
