Diabetic Ketoacidosis

Question 1

Define:

Answer 1

Acute metabolic complications of diabetes (type 1 usually) that can prove fatal due to insulin deficiency.

Question 2

Aetiology/risk factors:

Answer 2

can be triggered by:
surgery 
INFECTION
UTI
MI
pancreatitis
chemotherapy
psychotics
INAPPROPRIATE INSULIN THERAPY.

Rare in Type 2 as there is insulin to suppress the formation of ketones.

Question 3

Symptoms/signs:

Answer 3

o	Nausea and vomiting
o	Abdominal pain 
o	Polyuria, polydipsia
o	Drowsiness
o	Confusion
o	Coma
o	Kussmaul breathing 
o	Ketotic breath 
o	Signs of dehydration

Question 4

Investigations:

Answer 4

ANION gap - look at the anion in the blood

o	Capillary blood glucose  urine dipstick (check for glycosuria and ketonuria)  ABG (check for metabolic acidosis)  plasma osmolality 
o	FBC (raised WCC without infection in DKA)

Question 5

Management:

Answer 5

Depends on the blood profile:

IV fluids

Soluble insulin

Insulin sliding scale (continue until there is normalisation)

Potassium replacement

Monitor glucose + ketone + urine output

Broad spec antibiotics for infection

Thromboprophylaxsis

Question 6

Complications:

Answer 6

Hypoglycaemia

Hypokalaemia

Cerebral oedema/brain injury

Death

ARDS

Anterior venous thromboembolic events

Non-anion gap hypercholeracidosis

Question 7

Prognosis:

Answer 7

5% mortality