DIABETIC KETOACIDOSIS

Question 1

WHAT IS DIABETIC KETOACIDOSIS?

Answer 1

• Serious complication of T1DM (can be seen in T2DM)
• Body has insufficient insulin to allow enough glucose to enter cells, as a result body switches to burning fatty acids and producing acidic ketone bodies.

Question 2

WHAT IS THE BIOCHEMICAL TRIAD OF DKA?

Answer 2

1) Hyperglycaemia
2) Ketonemia
3) Metabolic acidosis

Question 3

WHAT ARE THE SYMPTOMS OF DKA?

Answer 3

1) Polyuria
2) Polydipsia
3) Weight loss.
4) Inability to tolerate fluids.
5) Persistent vomiting and/or diarrhoea.
6) Abdominal pain.
7) Lethargy and/or confusion

Question 4

WHAT ARE THE SIGNS OF DKA?

Answer 4

1) Fruity smell of acetone on the breath.
2) Hyperventilation- Kussmaul’s breathing (deep and rapid)
3) Dehydration
4) Shock- tachycardia, poor peripheral perfusion, hypotension, lethargy, drowsiness, or decreased level of consciousness (reduce cerebral perfusion), reduced urine output (indicating decreased renal perfusion).

Question 5

WHAT ARE THE RISK FACTORS FOR DKA?

Answer 5

1) significant hyperglycaemia >11 mmol/L
2) physiological stress (trauma or surgery)
3) inadequate insulin/ non-adherence to insulin therapy
4) drugs- corticosteroids
5) pancreatitis
6) infection

Question 6

WHAT ARE THE INVESTIGATIONS FOR DKA?

Answer 6

1) Blood ketones - > 3 mmol/L
2) Urine ketones - 2+
3) Blood glucose - >11mmol/L
4) Urea and electrolytes - hyponatraemia and hyperkalaemia (hypokalaemia in severe DKA)
5) FBC - leucocytosis
6) Venous blood gas - metabolic acidosis with raised anion gap

Question 7

WHAT IS THE TREATMENT FOR DKA?

Answer 7

Management involves replacement of fluids and electrolytes and insulin administration.

1) Restore circulating volume with IV infusion 500 ml sodium chloride 0.9%
2) Include potassium chloride in fluid unless anuria
3) IV insulin infusion