Diabetic Ketoacidosis Flashcards

1
Q

Define Diabetic Ketoacidosis

A

Acute metabolic complication of diabetes characterised by:
Hyperglycaemia
Ketonaemia
Acidosis

with rapid onset of symptoms

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2
Q

Aetiology of Diabetic Ketoacidosis

A

Starvation - alternative metabolic pathway to glucose metabolism -> acetone production
Diabetes - lack of insulin - excess glucose cannot be absorbed in cells -> severe acidosis and hyperglycaemia

Associated with T1DM (inadequate insulin therapy or infection)
Also caused by MI, stroke, drugs (steroids, thiazides, pentamide)

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3
Q

Risk factors for Diabetic Ketoacidosis

A
Inadequate/inappropriate insulin therapy 
MI 
Infection
Pancreatitis
Stroke
Acromegaly
Hyperthyroidism 
Drugs (steroids, thiazides, pentamide)
Cushing's
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4
Q

Presenting symptoms of Diabetic Ketoacidosis

A
Abdominal pain and vomiting 
Dehydration 
Gradual drowsiness
Polyuria, polydipsia
Polyphagia
Lethargy 
Anorexia 
Severe: coma, deep breathing
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5
Q

Signs of Diabetic Ketoacidosis

A
Tachycardia and hypotension
Ketotic/acetone breath 
Dehydration: poor skin turgor,  prolonged capillary refill
Kussmaul respiration (deep and rapid)
Hypothermia
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6
Q

Criteria for Diabetic Ketoacidosis diagnosis

A

Acidaemia (venous pH <7.3 or bicarb <15)

Hyperglycaemia (glucose >11/known DM)

Ketonaemia (>3mmol/L) OR significant ketonuria (>++)

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7
Q

Investigations for Diabetic Ketoacidosis

A

VBG/ABG: metabolic acidosis (ABG used if hypoxia present)
Plasma glucose: hyperglcuaemia
Capillary/serum/urine ketones: elevated

Look for precipitating factor e.g. CXR for infection, ECG for electrolyte imbalances or MI

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8
Q

Criteria for severe Diabetic Ketoacidosis

A
pH <7.0
Ketonaemia >6mmol/L
Bicarb <5
Potassium <3.5
GCS <12
Sats <92
Brady/Tachycardia
Anion gap <16
Systolic BP <90
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9
Q

Management for Diabetic Ketoacidosis

A
  1. 1L 0.9% saline over 1 hour (add 500mL boluses over 15mins if BP <90)
  2. Send blood tests for ketoacidosis

(If HYPOKALAEMIC - give POTASSIUM before insulin)

  1. Insulin, 50 units to 50ml 0.9% saline and infuse + continue long-acting insulin
  2. Consider catheter or NG tube (vomiting or drowsy) and catheter if no urine output
  3. When glucose <14 mmol/L -> start 10% glucose
  4. Continue fix rate insulin until ketones < 0.6 mmol/L
  5. Treat cause
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10
Q

Complications of Diabetic Ketoacidosis

A

Cerebral oedema
Aspiration pneumonia
Hypokalaemia/magnesaemia/phosphataemia
Thromboembolism

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11
Q

Prognosis Diabetic Ketoacidosis

A

Mortality rate 5% in experienced centres
Death often caused by the underlying illness
Prognosis worsened at extremes of age and with coma or hypotension

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