DKA Flashcards
Criteria for dx of DKA
pH <7.3 with mod ketonuria/ ketonemia
CBG >250
Anion gap >10
Bicarbonate <15
Cause of N/V & abdominal pain in DKA
Prostaglandin I2 & E2 release
Alteration of sensorium correlates better with elevated ___ than severity of metab acidosis
serum osmolality (>320)
Alteration of sensorium correlates better with elevated ___ than severity of metab acidosis
serum osmolality (>320)
Risk factors of DKA with euglycemic ketoacidosis (CBG <300)
Patients presenting shortly after receiving insulin
T1DM patient who are young and vomiting
Patient with impaired gluconeogenesis (alcohol abuse / liver failure)
Starvation
Depression
Pregnancy
Venous pH is __ lower than arterial pH
0.03
Minimum baseline dx test for DKA
CBG Urine ketones ECG CBC VBG Serum electrolytes (inc Phos, Mg, Ca) BUN, Crea Urinalysis
Minimum baseline dx test for DKA
CBG Urine ketones ECG CBC VBG Serum electrolytes (inc Phos, Mg, Ca) BUN, Crea Urinalysis
Only clue to underlying metab acidosis masked by concomitant volume contraction-related metab alkalosis
Elevated anion gap
Corrected Na
+1.6 meq for every 100 mg (5.5 mmol) of glucose
+2.4 meq (CBG>400)
Consider ICU dispo
AG >25
Glucose >800
Significant comorbidity
What to check before starting insulin drip
K
K >5.2
Regular insulin at 0.10-0.14 u/kg/hr
then repeat K STAT in 2 hrs
K 3.4-5.2
Add 20-30 meqs of K to each liter of IVF
Insulin drip same at 0.10- 0.14
K <3.3
Hold insulin drip
Give 20-30 meq/hr until K>3.3
What to check before initiating K therapy
UO
Rate of PNSS for the 1st hour
15-20 mL kg/hr
+ SD: 0.45 NaCl at KVO
After PNSS bolus for 1st hr, start __ for eunatremia/ hypernatremia
0.45 PNSS at 250-500 mL/h with K supplement
After PNSS bolus for 1st hr, start __ for hyponatremia
PNSS at 250 - 500 mL/hr
If pH <6.9
give 100 mmol NaHCO3 in 400 mL water with 20 eq KCl at 200 mL/hr
Repeat K every 2 hours
If blood glucose does NOT decrease by 10% (or 3 mmol/L/h) after 1 hour of insulin therapy
Give 0.14 u/kg insulin bolus then resume previous rate
If glucose decreasing faster than 50-75 mg/dL/hr
decrease insulin drip and check CBG q1
For young and new-onset DM patients, avoid excess free water and have standby ___ at bedside
Mannitol
When glucose approaches 200 (11 mmol/L) change IV to
D5 0.45 with 20-40 meq KCl/L
Decrease insulin rate to 0.02-0.05 units/kg/hr
DKA goals by 12-48 hrs
Maintain serum glucose to 180-200 mg/dL
AG normal
pH >7.3
HCO3 >18
Once glucose is controlled, discontinue IV insulin __ hrs after SC insulin
1-2
Initial K replacement should be no faster than
10 meq/h via peripheral IV
20 meq/h via central line access
Alternative to mannitol
Hypertonic saline (3%) 5-10 mL/kg over 30 mins
