Diabetic Ketoacidosis Flashcards
What are the five problems occurring in DKA?
Hyperglycaemia Ketosis Dehydration Metabolic acidosis with low bicarbonate Potassium imbalance
How is potassium affected in DKA?
Insulin normally drives potassium into cells
Serum potassium can be high or normal in DKA
But total body potassium is low (because none stored in cells)
When treated with insulin –> hypokalaemia
What are the symptoms of DKA?
Polyuria Polydipsia Nausea + vomiting Abdominal pain Acetone smell to breath Dehydration --> hypotension Kussmaul's (deep) breathing Altered consciousness Symptoms of trigger e.g. infection
What can trigger DKA?
Undiagnosed T1DM Poor diabetic control Infection Surgery MI Insulin pump failure
What is the diagnostic criteria for DKA?
All of:
- capillary glucose > 11 or known diabetes
- serum ketones >/= 3 or urine ketones 2+
- venous pH < 7.3 or bicarbonate < 15
How is DKA managed?
Follow local protocol carefully
- Normal saline through large bore cannula
- Insulin IV
- Monitor potassium carefully and correct if required
- Assess for underlying cause
- 10% IV glucose when blood glucose < 14 (continue until patient eating)
How much normal saline should be given in the initial management of DKA?
If SBP <90 –> 500ml/15mins + repeat if required
If/when SBP > 90 –> give 1 litre/hr, then 2 litre/4hr, then 2 litre/8hr
In children –> calculate fluids according to weight as risk of cerebral oedema
How much insulin should be given in the management of DKA?
- 1 unit/kg/hour
- 50 units of short/rapid acting insulin in bag with normal saline made up to 50ml
What should HDU transfer be considered for DKA?
Ketones > 6 Potassium < 3.5 GCS < 12 Acid base: - bicarb < 5, pH < 7.1, anion gap > 16 Vitals: - oxygen < 92% - SBP < 90 - HR < 60 or > 100
How should a patient be changed back to SC insulin after resolution of DKA?
Once eating and drinking
Overlap for first 30 mins with IV insulin
Give short acting with meals
What should happen to a patient’s normal insulin during an episode of DKA?
Continue basal insulin during DKA (makes transition back easier)
Stop bolus insulin until eating again
What is the main complication associated with DKA?
VTE + PE
–> consider LMWH
Which complications can occur as a result of treatment for DKA?
Cerebral oedema in children
Hypokalaemia
Hypoglycaemia
How should cerebral oedema be managed?
Mannitol or hypertonic saline
