Diabetic Ketoacidosis (DKA) Flashcards
1
Q
what is diabetic ketoacidosis (DKA)?
A
- a life-threatening medical emergency
- it is an acute complication of T1DM and is characterised by hyperglycaemia, hyperketonaemia, and metabolic acidosis
2
Q
what is the aetiology of DKA?
A
- inadequate insulin therapy
- infection
- stress
- medications (e.g. corticosteroids, thiazides, SGLT2 inhibitors)
- alcohol
- substance abuse
- pregnancy
3
Q
what is the pathophysiology of DKA?
A
- DKA occurs due to absolute or relative insulin deficiency, resulting in hyperglycaemia
- subsequent counter-hormone secretion (e.g. cortisol, glucagon, adrenaline), gluconeogenesis, and glycogenolysis lead to very high ketone levels, osmotic imbalance, acidosis, polyuria, dehydration, and electrolyte disturbance
4
Q
what are the symptoms of DKA?
A
- thirst
- polyuria
- oliguria
- abdominal pain
- nausea
- vomiting
- fatigue
- confusion
- palpitations
5
Q
what are the clinical signs associated with DKA?
A
- dehydration (e.g. tachycardia, hypotension, reduced skin turgor, dry mucous membranes)
- kussmaul breathing
- pear drop/acetone odour to the breath
- cerebral oedema (e.g. decreased consciousness)
6
Q
which three criteria must be met for a diagnosis of DKA to be made?
A
- hyperglycaemia: blood glucose > 11.0 mmol/L or known diabetes mellitus
- ketonaemia: capillary ketones > 3.0 mmol/L or urine ketones 2+ or more
- acidosis: venous pH < 7.3 and/or bicarbonate < 15.0 mmol/L
7
Q
what are the acute complications of DKA?
A
- AKI
- iatrogenic hypoglycaemia
- hyperkalaemia
- cerebral oedema
- pulmonary oedema
- pancreatitis
- rhabdomylolysis
- gastrointestinal bleeding
8
Q
what is the emergency management of DKA?
A
- IV fluid (e.g. 1L 0.9% NaCl in 1 hour)
- fixed-rate intravenous insulin infusion (FRIII) (e.g. 0.1 units/kg/hour)
- electrolyte replacement (e.g. IV potassium)
9
Q
what are the investigations for DKA?
A
- ABG/VBG
- FBC
- U&Es
- CRP
- LFTs
- serum glucose
- serum osmolarity
- capillary ketones/urine ketones
- ECG
