Diabetic ketoacidosis

Question 1

Symptoms & signs of DKA

9

Answer 1

nausea & vomiting
abdo pain
polyuria/dipsia
drowsiness
confusion
coma
kussmaul breathing
ketonic breath
signs of dehydration

Question 2

Investigations for DKA

9

Answer 2

FBC (raised WCC w/o infection)
U&Es (raised urea & creatinine due to dehydration)
LFT
CRP
Glucose
Amylase
Blood cultures
ABG (metabolic acidosis w/ high anion gap)
blood/urinary ketones

Question 3

Management of DKA

11

Answer 3

1) 50U soluble insulin in 50ml normal saline
(use insulin sliding scale)

2) continue until
- capillary ketones <0.3
- venous pH >7.30
- venous bicarbonate >18mmol/L

3) then change to SC insulin & don’t stop insulin infusion until 1-2 hrs after SC insulin has restarted
4) 500ml normal saline over 15-30mins until SBP>100
5) potassium replacement (because insulin drives potassium into cells)
6) monitor blood glucose, capillary ketones & urine output hourly
7) monitor U&Es & venous blood gas
8) broad spectrum antibiotics if infection is suspected
9) thromboprophylaxis
10) NBM for at least 6 hrs
11) NG tube if GCS is reduced