Diabetic Ketoacidosis

Question 1

Presentation and Ix of DKA

Answer 1

Present-
its gonna be acute presentation- so A-E Approach

usually young with central abdominal pain, confusion/coma
Hard breathes-weirdly deep and fast
sweaty, thin, hyperthermic
Weird smelling breath
Recent Hx of illness/unwell taht could be a trigger

and IMPORTANT- POLYURIA, POLYDYSPIA

Diagnostic criteria-
Glucose >11
pH <7.3
Bicarb <15mmol
Ketone >3, Ketone ++ on urine

so mainly ABG for all- but dipstick, capillary bloods
ECG and CXR mainly normal (if no assox electrolyte issues)

Question 2

Management of DKA

Answer 2

The key is immediate and agressive fluid ressus (on average they lose 5-8L of fluid)
ISOTONIC saline –1L over 1st H, then 1L over next 2, then 1L over next 2 etc

Insulin-continue basal dosage, and add insulin at 0.1 Unit/KG/H (so 7.5U/H on average)
Monitor glucose and if under 15- add dextrose 5%

Potassium- as insulin will reduce
if over 5.5- fine leave alone
3.5-5.5- 40mmol K+
<3.5 - seniooor

resolve Acidosis and Ketosis within 24h
target pH>7.3
Ketone<0.6
Bicarb >15

monitor main complications of DKA
Hyperkalemia
Hypokalemia, thromboembolism
Cerbreal oedema,
ARDS
AKI

Question 3

Complications of DKA

Answer 3

monitor main complications of DKA
Hypokalemia, Hyperkalemia thromboembolism
cause of fluid– Cerbreal oedema, hypoglycemia,
ARDS
AKI

young children especially vulnberable to cerebral oedema and need constant neuro obs taken–often occurs with 4-12h of fluids
if so CT and senior