Diabetic ketoacidosis

Question 1

diagnosing a DKA?

Answer 1

↑ ketones >3 (or +++)
↓ pH <7.3 (or HCO3 <15)
↑ glucose >11 (or known DM)

Question 2

complications of DKA?

Answer 2

• polyuria and V → dehydration → pre-renal AKI → ↑K+
• dehydration → ↑haematocrit → ↑VTE risk
• dehydration → fluids given too quickly → ↑cerebral oedema risk
• ↓K+
• ↓glucose

Question 3

Sx DKA?

Answer 3

N, V (due to gastroparesis and attempt to remove H+)
abdo pain
polydipsia+uria
lethargy
↓ LOC

Question 4

Ex DKA?

Answer 4

↓ BP (+pulse P.)
↑ HR
dehydration
Kussmaul's (deep) breathing
ketotic breath
\+/- infection

Question 5

Ix DKA?

Answer 5

• BEDSIDE:

• finger-prick glucose + ketones
• ECG (K+)
• urine dip

• BLOODS:

• *VBG ↓pH + HCO3
• ↑U+E
• anion gap, osmolality
• FBC ↑wbc (even when no infection)
• cultures, lactate
• ↑amylase
• lab glucose, ketones

• IMAGING:
- CXR

Question 6

what happens to K+ levels in DKA?

Answer 6

↓ insulin, ↑ osmolality, ↓ pH
= ↑ extracellular K+
(but ↓ total body K+)

Tx falling K+ after giving insulin by putting K+ in second bag of IVT

Question 7

Tx DKA?

Answer 7

• NaCl 1 litre over 1 hour (bolus if BP<90)
give 1 litre in 1:2:2:4:4:6 hrs
• Actrapid IV 0.1 units/kg/hr made up to 50ml
• in second IVT after blood results, K+ 40mmol over 2 hours (if normal)
• 10 percent glucose (when <14)
• when eating, stop glucose start S/C insulin

Question 8

Sx of SEVERE DKA?

Answer 8

• ketones >6
• acid-base: HCO3 <5, pH <7, anion gap >16
• K+ <3.5
• GCS <12
• vitals: sats <92, BP <90, HR >100 or <60

ITU - central venous access

Question 9

complication of DKA to beware in kids? Tx?

Answer 9

cerebral oedema (headaches, altered mental status/BP/HR, pupils, apnoea)

Tx with mannitol or hypertonic saline

Question 10

continue long-acting insulin in DKA Tx?

Answer 10

yes