Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State Cases Flashcards
T/F Insulin causes Potassium to shift into the cells thereby decreasing the extracellular K level.
true - insulin stimulates potassium uptake into cells
How is insulin secretion affected by extracellular K+ level?
Level of Potassium in the serum also affects insulin secretion from the pancreas.
In hyperkalemia more K will enter the beta cell and insulin secretion will increase
In hypokalemia insulin secretion will decrease.
How does insulin affect magnesium and phosphate?
insulin creases permeability of cell membranes to magnesium, potassium and phosphate
how does growth hormone affect glucose metabolism in contrast to insulin?
increeased AA uptake in muscle (AA anabolic effect on muscle - opposite from cortisol!)
Increased lipolysis
increased gluconeogenesis in liver
decreased glucose uptake in muscle and fat
Hyperosmotic hypovolemic syndrome is associated with what changes in metabolism?
increased counter-regulatory hormones and relative (trandsient) insulin defficiency that results in hyperglycemia and osmotic diuresis, polyuria, polydipsia, tissue hypo-perfusion and lactic acidosis
function of insulin is maintained enough to prevent lypolysis and ketogenesis not enough to prevent gluconeuogenesis or facilitate appropriate glucose utilization by peripheral tissues
How does the diagnostic criteria differ from HSS and DKA?
DKA: hyperglycemia, metabolic acidosis, ketogenesis
HSS: hyperglycemia, hyperosmolality, dehydration (absent ketogenesis)
what are the pH cut-off’s for HSS/DKA?
> 7.3 = HSS (plasma glucose >600mg/dl; bicarb >18; effectvie serum osmolality >320; small urine ketone; variable anionic gap; metal status is markedly impaired!)
250mg/dl; bicarb 10; mental status is variably impaired)
What differentiates mild moderate and severe DKA?
mild = 7.25-7.3 pH; 15-18 bicarb; anion gap >10; alert moderate = 7.24-7pH; 15-10 bicarb; gap >12; alert/drowsy severe = 12; stupor/coma
abdominal discomfort, vomiting, vascular shock, mental status changes and kassmusal breathing are signs of what?
DKA
Why should anion gap be monitored over kotone levels?
only acetoacetate is measured and as redox state is increased (high NAD+/NADH) conversion of acetoacetate to beta-hydroxybuterate is increased ==> could show low/normal ketone levals in severe DKA or increasing levels in response to treatment
Why should anion gap be monitored over glucose levels?
glucose in DKA is >250 but with fluids and insuin can return to normal levels faster than pH changes take place falsely indicating resolution of metabolic imabalance
Acidemia results in _____ K+ levels?
Increased potassium levels because of extracellular to intracellular ion exchange.
insulinopenia results in _____ K+ levels?
increased potassium levels due to decreased potassium uptake by cells
T/F Total body potassium is elevated in DKA
False - total K+ is decreased because extracellular K+ is lost via osmotic diuresis (still kyperkalemic!!!)
T/F In DKA, serum potassium will likely drop with treatment
true - insulin causes shift of potasium into cells. Replacement of serum K+ is initiated once K+ levels fall (if renal function is determined healthy).
