Diabetic Ketoacidosis

Question 1

Presenting symptoms and signs on physical examination

Answer 1

o Nausea and vomiting
o Abdominal pain
o Polyuria, polydipsia
o Drowsiness
o Confusion
o Coma
o Kussmaul breathing
o Ketotic breath
o Signs of dehydration

Question 2

Investigations

Answer 2

o FBC (raised WCC without infection in DKA)
o U&Es (raised urea and creatinine due to dehydration)
o LFT
o CRP
o Glucose
o Amylase
o Blood cultures
o ABG (metabolic acidosis with high anion gap)
o Blood/urinary ketones

Question 3

Management plan

Answer 3

o 50 U soluble insulin in 50 mL of normal saline

o Use an insulin sliding scale

o Continue until:
· Capillary ketones < 0.3
· Venous pH > 7.30
· Venous bicarbonate > 18 mmol/L

o From this point onwards change to SC insulin

o Don’t stop the insulin infusion until 1-2 hrs after the SC insulin has restarted

o 500 mL normal saline over 15-30 mins until SBP > 100

o Potassium replacement (because insulin drives potassium into cells)

o Monitor blood glucose, capillary ketones and urine output hourly

o Monitor U&Es and venous blood gas

o Broad spectrum antibiotics if infection is suspected

o Thromboprophylaxis

o NBM for at least 6 hrs

o NG tube if GCS is reduced

Question 4

Possible complications

Answer 4

o Can be precipitated by infection, errors in management of diabetes, newly diagnosed diabetes, idiopathic