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University > Diabetic Ketoacidosis > Flashcards

Diabetic Ketoacidosis Flashcards

1
Q

What is the definition of Diabetic Ketoacidosis (DKA)

A

DKA is a metabolic state characterised by hyperglycaemia, acidosis and ketonuria

It is severe uncontrolled diabetes requiring emergency treatment with insulin and IV fluids

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2
Q

What is the annual incidence rate per 100 type 1 diabetic patient

A

1-5 episodes per 100

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3
Q

What age does it usually occur?

A

<19 but may occur at any age. Most common cause of death in Uk for people with diabetes <20

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4
Q

Is it more common in males or females?

A

Twice as common in females

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5
Q

What is the average mortality of DKA?

A

5-10%

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6
Q

Does the mortality rise or lower with age?

A

Rises with age. 50% >80 years

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7
Q

What are the precipitating factors?

A 
Infection 
New case of type one diabetes
Insulin error
Myocardial infarction 
Stressful events
Pregnancy
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8
Q

What problems would the patient face?

A 
Tiredness/lethargic
Hyperglycaemia 
Glycosuria
Polyuria
Dehydration
Ketonuria
Ketones on breath
Weight loss
Nausea/vomiting
Abdo pain
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9
Q

What is the progression of DKA?

A

Drowsy- semi conscious- unconscious

Dehydration- hypovalaemic shock 
Low bp- tachycardia- higher resp rate
Oliguria 
Dry skin
Hyperglycaemia 
Kyperketonaemia 
Metabolic acidosis

Breathlessness- kussmals
Loss of potassium- effect on t wave- arrhythmias
Loss of sodium
Signs of infection

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10
Q

What are the priorities?

A 
Airway
Unconscious patient
Treat shock 
Reduce blood sugar 
Replace loss of sodium and potassium
Find cause
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11
Q

What observations are needed?

A 
Neuro obs 
Bp, temp, Hr, RR
Hourly bms 
Hourly urine output
Hourly cvp
Cardiac monitor
Blood gases
Urea and electrolytes
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12
Q

What would you do with regards to airway/breathing?

A 
Assessment 
Position 
Nil orally
Naso gastric tube and aspirations
Oxygen
Pulse oximetry
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13
Q

What would you do for shock?

A

Monitor/ obs
Catheterise and hourly urine output
Fluid balance chart
Fluids IVI 500mls stat, then saline 1000 over one hour, 1000 over two hours then 1000 over four hours
Change to 6% dextrose when BG below 15mmol

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14
Q

What would you do for hyperglycaemia?

A

Monitor/ hourly bms and 2 hour venous sample
Soluble insulin via a pump
Possible sliding scale
Aim to reduce glucose by 3mmol/h
Short acting insulin (humulin s/actrapid)
50 mil sodium chloride 0.9% via a syringe driver 1 unit/milb@ 6 units/h or as prescribed

If <16mmol reduce to 3-4 Units/hour
10-15mmol reduce time 2-3 units

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15
Q

What do you do for hypokalaemia/ hyponatraemia?

A

Cardiac monitor
IV potassium chloride prescribes in accordance to blood chemistry
Initially 10-30mmol/L administered with I.V fluids via a syringe driver
Sodium chloride infusion

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16
Q

What other investigations could you do?

A 
Blood cultures
ECG
Chest x ray
Urine and sputum for culture 
Swab any potential infection
Pregnancy test
17
Q

What do you do for prevention?

A

Sick day rules:

Never stop insulin and check for ketones

Measure bms four times a day
If bm < 11mmol continue normal insulin
If bm 11-17mmol add extra 4 unit with meals
If bm>add extra 6 units with meals, drink milk, fruit juice and 5 pints of sugar free fluid a day
If nausea and vomiting and bm >17 call dr

18
Q

What is hypoglycaemia?

A

Common side effect of treatment with insulin or sulphonylureas

Does not occur with metformin or diet alone

Yearly 25-30% of all insulin treated patients have one or more episodes of severe hypoglycaemia

19
Q

What are the predisposing factors of hypoglycaemia?

A 
Inadequate food intake
Excess dosage
Exercise 
Weight loss 
Alcohol
20
Q

What are the stages of hypoglycaemia?

A

Asymptomatic - awake or asleep

Mild symptomatic patient able to treat themselves

Severe symptomatic - help needed to treat hypoglycaemic attack

Coma

21
Q

What are the symptoms of hypoglycaemia?

A 
Sweating 
Palpitations
Tremor 
Hunger 
Confusion 
Clumsiness
Behavioural changes
Temper tantrums in children
22
Q

What is the treatment for hypoglycaemia?

A

Mild
Treat immediately with oral glucose

If patient unable to swallow
IV 50% dextrose 30-50mls
IM GLUCAGON (1mg)

Patients should recover immediately

University (7 decks)

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