Diabetic Ketoacidosis Flashcards

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1
Q

What is the mechanism of ketoacidosis?

A

Normally, the body metabolises carbohydrates, leading to efficient energy production. Ketoacidosis is an alternative metabolic pathway used in starvation states, which is far less efficient, and produces acetone as a byproduct.

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2
Q

What happens in acute ketoacidosis?

A

There is excessive glucose, but because of a lack of insulin, this cannot be taken up into cells to be metabolised, pushing the body into a starvation-like state where ketoacidosis is the only mechanism of energy production.

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3
Q

Why is acute ketoacidosis medically important?

A

The combination of severe acidosis and hyperglycaemia can be deadly, and so early recognition and treatment is important

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4
Q

What is the typical presentation of diabetic ketoacidosis?

A
  • Gradual drowsiness
  • Vomiting
  • Dehydration
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5
Q

What patients should you measure glucose in?

A

All those with;

  • Unexplained vomiting
  • Abdominal pain
  • Polyuria
  • Polydipsia
  • Lethargy
  • Anorexia
  • Ketotic breath
  • Dehydration
  • Coma
  • Deep breathing
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6
Q

What are the triggers for diabetic ketoacidosis?

A
  • Infection
  • Surgery
  • MI
  • Chemotherapy
  • Pancreatitis
  • Anti-psychotics
  • Wrong insulin dose/non-compliance
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7
Q

What are the diagnostic criteria for diabetic ketoacidosis?

A
  1. Acidaemia, with a venous blood pH <7.3 or HCO3- <15mmol/L
  2. Hyperglycaemia, with blood glucose >11mmol/L, or known diabetes mellitus
  3. Ketonaemia (>3mmol/L), or significant ketonuria (more than 2+ on dipstick)
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8
Q

What investigations should be done in diabetic ketoacidosis?

A
  • ECG
  • CXR
  • Urine dipstick and MSU
  • Capillary and lab glucose
  • Blood ketones
  • VBG (or ABG if decreased GCS or hypoxia)
  • U&E
  • Osmolality
  • FBC
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9
Q

What are the criteria for a severe DKA?

A
  • Blood ketones >6mmol/L
  • Venous bicarbonate <5mmol/L
  • Venous/arterial pH <7.0
  • K <3.5mmol/L on admission
  • GCS <12
  • Sats <92% on air (assuming no respiratory disease)
  • Systolic BP <90mmHg
  • Pulse >100 or <60bpm
  • Anion gap above 16
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10
Q

What should be done if a patient presents with severe DKA?

A
  • Consider transfer to HDU/ITU for monitoring and central venous access
  • Get senior help
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11
Q

What are the steps in acute management of diabetic ketoacidosis?

A
  1. Insert 2 large-bore cannulae
  2. Start fluid 1L 0.9% saline over 2 hour (if systolic BP <90mmHg, give 500ml bolus over 15 mins and reassess. If systolic BP still <90mmHg, give another 500ml bolus and seek senior review. If still <90mmHg, ICU)
  3. Venous blood gas for pH and bicarbonate, bedside and lab glucose and ketones, and other tests
  4. Insulin
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