Diabetic Ketoacidosis Flashcards
What is diabetic ketoacidosis (DKA)?
An acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. It is characterised by absolute insulin deficiency and is the most common acute hyperglycaemic complication of type 1 diabetes mellitus.
What risk factors are associated with DKA?
- Infection
- Pneumonia and UTI
- Discontinuation of insulin (unintentional or deliberate)
- Inadequate insulin
- Malfunctioning insulin pen or pump and
degradation of insulin due to storage at incorrect temperature
- Malfunctioning insulin pen or pump and
- New onset diabetes
- Acute illness
- Myocardial infarction, sepsis and pancreatitis
- Drug history
- Corticosteroids, thiazides, sympathomimetics, cocaine, cannabis, and acute intoxication with alcohol
- Physiological stress
- Pregnancy
What are the signs of DKA?
- Acetone smell on breath
- Hyperventilation
What are the symptoms of DKA?
- Known diabetes or features of diabetes e.g. increased thirst, polyuria, recent unexplained weight loss or excessive tiredness
- Nausea and vomiting
- Abdominal pain
- Dehydration
- Reduced consciousness
What investigations should be ordered for DKA?
- Venous blood gas
- Blood ketones
- Blood glucose
- Urea and electrolytes
- FBC
What are the parameters for diagnosing DKA?
- Blood ketones are ≥3.0 mmol/L OR there is ketonuria (more than 2+ on standard urine sticks); AND
- Blood glucose is >11.1 mmol/L OR known diabetes; AND
- Bicarbonate (HCO3-) is <15.0 mmol/L AND/OR venous pH is <7.3.
Why investigate using venous blood gas? And what may this show?
- Use the pH to determine the severity of DKA:
- pH ≥7.0 indicates mild or moderate DKA
- pH <7.0 indicates severe DKA
- Metabolic acidosis with a raised anion gap
Why use venous blood gas rather than arterial blood gas?
Venous blood gas testing may have a lower risk of serious adverse events (e.g., vascular occlusion or infection), is less painful for the patient, and is technically easier to perform than arterial blood gas testing.
Why investigate blood ketones? And what may this show?
- Assessment of ketones should be done at or near the bedside, use urinary ketones if blood is not available
- Ketonaemia (ketones ≥3.0 mmol/L)
Why investigate blood glucose? And what may this show?
- Assessment of glucose should be done at or near the bedside
- Hyperglycaemia (blood glucose >11.1 mmol/L)
Why investigate urea and electrolytes? And what may this show?
- Hyponatraemia and hyperkalaemia are common but hypokalaemia is an indicator of severe DKA
- May show hypomagnesaemia and hypophosphataemia
Why investigate FBC? And what may this show?
- Leukocytosis is common in DKA and correlates with blood ketone levels
What are the 4 aspect which need to be managed in DKA treatment?
- IV fluid
- Potassium
- Insulin
- Resolution
Briefly describe the IV fluid treatment of DKA
Briefly describe the treatment of potassium in DKA