DKA Flashcards
Is ketoacidosis a more or less efficient metabolic pathway?
Less efficient
In what state is the metabolic pathway of ketoacidosis used by the body?
Starvation state
What byproduct does ketoacidosis produce?
What does this cause?
Acetone
Fruity breath smell
What is the typical picture of DKA?
Vomiting
Dehydration
Gradual drowsiness
Usually type 1
Which type of diabetes does DKA more commonly occur in?
Type 1
How is DKA diagnosed?
- Acidaemia (venous blood pH <7.3) OR (HCO3- <15mmol/L)
- Hyperglycaemia (BG 11+ mmol/L)
- Ketonaemia (3+ mmol/L) OR ketonuria (2+ on dipstick)
What are the investigations of DKA?
ECG CXR Urine (dipstick + MSU) Blood Capillary + lab glucose Ketones pH (use venous blood) U&E HCO3- Osmolality FBC Blood culture
What will be seen on an ECG of DKA?
What are these changes caused by?
Tall T waves
Prolonged QT interval
Broad QRS complex
Hyperkalaemia
Hypocalcamia
Why is a CXR done for DKA?
To rule out chest infections e.g pneumonia
What will be seen on a urine dipstick of DKA?
Ketonuria (2+ on dipstick)
What will be seen on capillary and lab blood glucose in DKA?
11+ mmol/L
What will be seen on blood ketone tests in DKA?
3+ mmol/L
What will be seen on blood pH tests in DKA?
<7.3
What will be seen in U&Es in DKA?
What is the cause of this?
High urea/creatinine
Dehydration / reduced renal function
What will be seen on HCO3- blood tests in DKA?
<15 mmol/L
What are the criteria for severe DKA?
One of
Ketones 6+ mmol/L Venous bicarbonate <5 mmol/L Venous/arterial pH <7 K <3.5 mmol/L GCS <12 O2 sat <92% Syst BP < 90 Pulse 100+ / <60 Anion gap 16+
What should be done in severe DKA?
Send to ICU
Get senior help
What is the general management of DKA?
Replace vol and correct metabolic defects
What is the first thing in DKA management?
Start 1L 0.9% saline over 1h
If syst BP <90 then 500ml bolus over 15 mins
If still <90 then 500ml bolus + senior review
If still <90 then ICU
What is the insulin management of DKA?
Add 50 units to 50ml 0.9% saline
Infuse that @ 0.1 units/kg/h
Aim for 0.5mmol/L/h fall in blood ketones OR 3 mmol/L/h rise in venous bicarbonates OR 3 mmol/L/h fall in blood glucose
What should be checked hourly when DKA is being managed?
Ketones
BG
Why are the K needs checked in DKA management?
Because insulin treatment will cause K to go into cells which could cause hypokalaemia
What are the complications of DKA?
Cerebral oedema (get help if sudden CNS decline) Aspiration pneumonia Hypokalaemia Hypomagnesaemia Hypophospataemia Thromboembolism
How can DKA be prevented?
Talk 2 patient
Evaluate compliance
Educate about triggers
