Diabetic ketoacidosis II

Question 1

What are the diagnostic criteria for diabetes mellitus?

Answer 1

• Symptoms of diabetes and a a random glucose >=200mg/dl

OR

• Fasting plasma glucose >= 126 mg/dl

OR

• 2hr plasma glucose >=200mg/dl during an oral glucose tolerance test

OR

• Hemoglobin A1c >= 6.5 (in adults)

Question 2

What are clinical features of diabetes mellitus?

Answer 2

Polyuria, Polydypsia, Polyphagia

Nocturnal enuresis

Weight loss

Ketoacidosis: abdominal pain, nausea, vomiting, mental status changes

Fatigue, weakness

blurry vision

Genital yeast infections

Question 3

What is the pathophysiology of T1 DM?

Answer 3

Autoimmune destruction of pancreatic beta cells ( that secrete insulin)

–> Tcell mediated

–> Lymphocytic infiltration

Question 4

What is the Two Hit Hypothesis?

Answer 4

Hypothesis of risk factors for T1 DM

• *Genetic Susceptibility** to diabetes:
• assoc. w/HLA DR3/4, DQ2/8 alleles
• *Environmental Triggers**:
• Viruses: congenital rubella
• Nutritional factors: early exposure to cow’s milk and vit D deficiency

Question 5

What are the biochemical criteria for Diabetic Ketoacidosis?

Answer 5

D = Hyperglycemia

K = Ketonemia or ketonuria

A = Venous pH <7.3 or HCO3 < 15mmol/L

Question 6

What is the pathophysiology of Diabetic Ketoacidosis?

Answer 6

Question 7

How is DKA treated?

Answer 7

1. Fluids: Only enough to reverse dehydration and replace ongoing losses (too much can lead to cerebral edema)

2. Insulin: To supress ketosis and reverse acidosis

3. Electrolytes: Replace profound Na and K losses

Question 8

What are signs and symptoms of cerebral edema?

Answer 8

Sudden, persistent drop in HR

Change in sensorium

Headache

Emesis

Incontinence

Unexplained tachypnea

Fall in serum Na or failure to rise

Question 9

What is the prayer sign?

Answer 9

Limited joint mobility due to uncontrolled diabetes

Fingers are unable to fully extend in a prayer position

• Associated with increased risk of retinopathy and nephropathy