Diabetic Ketoacidosis Flashcards
What precipitates diabetic ketoacidosis
A new T1DM diagnosis
Not taking insulin
Fasting
Stress
Effects of elevated insulin
High HGO and deficient muscle glucose uptake
How does insulin deficiency result in an increased HGO
Insulin should inhibit proteolysis and lipolysis but if is deficient then triglycerides are broken down into glycerol which liver can use for gluconeogenesis
Breakdown of proteins results in formation of amino acids which travel to liver. Gluconeogenic amino acids can be used for gluconeogenesis
What happens to fatty acids from lipolysis
Travel to liver and are used to make ketone bodies
Ketone bodies normally made from fatty acids
Acetoacetate
3-hydroxybutyrate
What effect does insulin deficiency have on ketone body production
Insulin would normally inhibit production of Ketone bodies from fatty acyl coA at level of mitochondrial membrane but as there is no insulin ketone body production increases
Why is there metabolic acidosis with diabetic ketoacidosis
Reduction in HCO3 as a result of its impaired production and increased H+ buffering
Clinical features of DKA
Dehydration
Total body K deficieny but plasma hyperkalaemia
Acidotic
Risk of arrhythmia and infection
Clinical signs of DKA
Polyuria and polydipsia Dehydration Hyperventilation Abdominal pain Coma Glycosuria Ketonuria
How to test for DKA
Ketones in the urine
ABG to show metabolic acidosis
Metabolic acidosis ABG
Low bicarbonate
Low pH
Low CO2
Treatment of DKA
Fluid
Insulin
Potassium
Bicarb
Main effect of insulin deficiency
Hyperglycaemia
Ketosis
Main effect of hyperglycaemia
Osmotic diuresis
Main effect of ketosis
Acidosis