Diabetic Ketoacidosis Flashcards
Define diabetic ketoacidosis.
Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus.
Explain the aetiology/risk factors of diabetic ketoacidosis.
Poor control of DM (particularly type I)
Infection
MI
Summarise the epidemiology of diabetic ketoacidosis.
In England, the incidence of hospital admissions for DKA among adults with type 2 diabetes increased 4.24% annually between 1998 and 2013; hospitalisations for DKA in adults with type 1 diabetes increased from 1998 to 2007, and remained static until 2013.
Recognise the presenting symptoms of diabetic ketoacidosis.
Polyuria
Polyphagia
Polydipsia
Weight loss
Weakness
Nausea or vomiting
Abdominal pain
Recognise the signs of diabetic ketoacidosis on physical examination.
Dry mucous membranes
Poor skin turgor
Sunken eyes
Tachycardia
Hypotension
Acetone breath
Altered mental status
Identify appropriate investigations for diabetic ketoacidosis and interpret the results.
U+Es
BM
Serum salts (sodium, potassium, magnesium)
Urinalysis
LFTs
ABG
Serum lactate
Serum amylase
Serum osmolality
FBC
Generate a management plan for diabetic ketoacidosis.
Fluid replacement: IV or oral fluids until rehydrated. This replaces the fluid lost through excessive urination as well as dilutes the excess ketones in the blood.
Electrolyte replacement: The absence of insulin can decrease the level of several electrolytes in blood. IV electrolyte is usually given.
Insulin therapy: Insulin reverses the processes that cause diabetic ketoacidosis. Once BM falls to about 11.1 mmol/L, stop IV insulin and resume normal insulin therapy.
Identify the possible complications of diabetic ketoacidosis and its management.
Hypoglycaemia
Hypokalaemia
Arterial or venous thromboembolic events
Non-anion gap hyperchloremic acidosis
Cerebral oedema/brain injury
Acute respiratory distress syndrome (ARDS)
Summarise the prognosis for patients with diabetic ketoacidosis.
The mortality rate is 5% in experienced centres. Death is rarely caused by the metabolic complications of hyperglycaemia or ketoacidosis but rather relates to the underlying illness. The prognosis is substantially worsened at the extremes of age and in the presence of coma and hypotension.
