DKA

Question 1

Criteria for dx of DKA

Answer 1

pH <7.3 with mod ketonuria/ ketonemia
CBG >250
Anion gap >10
Bicarbonate <15

Question 2

Cause of N/V & abdominal pain in DKA

Answer 2

Prostaglandin I2 & E2 release

Question 3

Alteration of sensorium correlates better with elevated ___ than severity of metab acidosis

Answer 3

serum osmolality (>320)

Question 3

Alteration of sensorium correlates better with elevated ___ than severity of metab acidosis

Answer 3

serum osmolality (>320)

Question 4

Risk factors of DKA with euglycemic ketoacidosis (CBG <300)

Answer 4

Patients presenting shortly after receiving insulin
T1DM patient who are young and vomiting
Patient with impaired gluconeogenesis (alcohol abuse / liver failure)
Starvation
Depression
Pregnancy

Question 5

Venous pH is __ lower than arterial pH

Answer 5

0.03

Question 6

Minimum baseline dx test for DKA

Answer 6

CBG
Urine ketones
ECG
CBC
VBG
Serum electrolytes (inc Phos, Mg, Ca)
BUN, Crea
Urinalysis

Question 6

Minimum baseline dx test for DKA

Answer 6

CBG
Urine ketones
ECG
CBC
VBG
Serum electrolytes (inc Phos, Mg, Ca)
BUN, Crea
Urinalysis

Question 7

Only clue to underlying metab acidosis masked by concomitant volume contraction-related metab alkalosis

Answer 7

Elevated anion gap

Question 8

Corrected Na

Answer 8

+1.6 meq for every 100 mg (5.5 mmol) of glucose

+2.4 meq (CBG>400)

Question 9

Consider ICU dispo

Answer 9

AG >25
Glucose >800
Significant comorbidity

Question 10

What to check before starting insulin drip

Answer 10

K

Question 11

K >5.2

Answer 11

Regular insulin at 0.10-0.14 u/kg/hr

then repeat K STAT in 2 hrs

Question 12

K 3.4-5.2

Answer 12

Add 20-30 meqs of K to each liter of IVF

Insulin drip same at 0.10- 0.14

Question 13

K <3.3

Answer 13

Hold insulin drip

Give 20-30 meq/hr until K>3.3

Question 14

What to check before initiating K therapy

Answer 14

UO

Question 15

Rate of PNSS for the 1st hour

Answer 15

15-20 mL kg/hr

+ SD: 0.45 NaCl at KVO

Question 16

After PNSS bolus for 1st hr, start __ for eunatremia/ hypernatremia

Answer 16

0.45 PNSS at 250-500 mL/h with K supplement

Question 17

After PNSS bolus for 1st hr, start __ for hyponatremia

Answer 17

PNSS at 250 - 500 mL/hr

Question 18

If pH <6.9

Answer 18

give 100 mmol NaHCO3 in 400 mL water with 20 eq KCl at 200 mL/hr

Repeat K every 2 hours

Question 19

If blood glucose does NOT decrease by 10% (or 3 mmol/L/h) after 1 hour of insulin therapy

Answer 19

Give 0.14 u/kg insulin bolus then resume previous rate

Question 20

If glucose decreasing faster than 50-75 mg/dL/hr

Answer 20

decrease insulin drip and check CBG q1

Question 21

For young and new-onset DM patients, avoid excess free water and have standby ___ at bedside

Answer 21

Mannitol

Question 22

When glucose approaches 200 (11 mmol/L) change IV to

Answer 22

D5 0.45 with 20-40 meq KCl/L

Decrease insulin rate to 0.02-0.05 units/kg/hr

Question 23

DKA goals by 12-48 hrs

Answer 23

Maintain serum glucose to 180-200 mg/dL
AG normal
pH >7.3
HCO3 >18

Question 24

Once glucose is controlled, discontinue IV insulin __ hrs after SC insulin

Answer 24

1-2

Question 25

Initial K replacement should be no faster than

Answer 25

10 meq/h via peripheral IV

20 meq/h via central line access

Question 26

Alternative to mannitol

Answer 26

Hypertonic saline (3%) 5-10 mL/kg over 30 mins