DKA

Question 1

DKA

DKA =

Answer 1

DM (usually type 1) + ↑↑↑gluc + ↓insulin + ↑ketones.
DKA pts ∼100 ml/kg fluid depleted.

Question 2

DKA

ASAP:

Answer 2

ABCs, 2 LB IVs, O2, monitor, VS

Question 3

DKA

DKA Hx:

Answer 3

Polyuria, polydipsia, fatigue, N/V, abd pain, HA/AMS; prev DKA / EtOH / AKA; meds

Question 4

DKA

The 7 I’s (causes):

Answer 4

Infection
Ischemia
Intoxication
Infraction/intolerance- not taking insulin, insulin pump problem
Iatrogenic - steroids, surgery
Initial Presentation
Impregnation

Question 5

DKA

Physical:

Answer 5

Dry, ↑HR, ↑RR (compensation for acidosis), Kussmaul resp (deep rapid breathing), lethargy, abd ttp, acetone odor

Question 6

DKA

Labs:

Answer 6

Labs: Accu✓, VBG w lytes, CBC, BMP, Ca/Mg/Phos, ketones, lactate, lipase, LFTs, blood cx; UA w cx, hCG; CXR, ± EKG (for ↑K or ischemia)

Question 7

DKA

Flowsheet:

Answer 7

q 1 hr VS, BMP, strict I/Os; q 4 h Ca, Mg, Phos

Question 8

DKA

Treatment Fluids :

Answer 8

NS bolus, then NS 1-2 ml/kg/hr (or 20 mL/kg in peds) add Dextrose once gluc < 250 mg/dl. can switch to ½ NS.
→ NS causes non anion-gap hyperchloremic metabolic acidosis. Can cause already low bicarb to decrease. Consider using LR instead.

Question 9

DKA

Treatment Insulin :

Answer 9

-0.1 u/kg/hr. Change to SC insulin when AG closed, tol PO, and pH > 7.2 (2 hr overlap required).
-Hold if K < 3.5; do not drop gluc > 100 mg/dl/hr. No bolus in peds.
→ Consider starting long acting insulin early

Question 10

DKA

Treatment Electrolytes :

Electrolytes:

Answer 10

“K+: add 20-40 mEq/L to IVF til K > 4.5 K (corr) = expect drop of 0.6 mEq per 0.1 pH of acidosis (hypo K = #1 cause of death) (insulin and correcting acidosis will shift K into cell)
Phos: replete if < 1.0
Na (corr) = add 1.6 per 100 of gluc > 200
Bicarb: unless pH <7 or concomitant lactic acidosis and refractory hypotension
→ Consider isotonic bicarb infusion when ketoacidosis almost fixed. Especially if have low bicarb.
Predicted bicarb = Na -Cl - 10”

Question 11

DKA

Treatment if Cerebral Edema :

Answer 11

S/Sx: HA/AMS, N/V, papilledema, sz
Rads: Head CT
Tx: Mannitol 1 g/kg IV, Intubate PRN (CE risk fx: kids and severe lab abnormalities)

Question 12

DKA

Pathology:

Answer 12

acetoacetate,beta-hydroxybutyrate, acetone. can only detect acetoacetate. in vol deficient shifts to beta
Insulin deficiency (secretion or production) and elevated counter-regulatory hormones → decreased cellular uptake, increased liver
gluconeogenesis and lipolysis → hyperglycemia, anion-gap metabolic acidosis, ketonemia