DKA

Question 1

What is diabetic ketoacidosis?

Answer 1

Life-threatening medical emergency

Question 2

How do most children with a new diagnosis of T1DM present?

Answer 2

DKA

Question 3

Clinical features of DKA

Answer 3

Polyuria

Polydipsia

Nausea and vomiting
Weight loss

Acetone smell to their breath

Dehydration and subsequent hypotension

Altered consciousness

Symptoms of an underlying trigger (i.e. sepsis)

Question 4

Pathophysiology of DKA

Answer 4

Ketogenesis normally occurs when there is insufficient supply of glucose and glycogen stores are exhausted

Ketones are water soluble fatty acids that can be used as fuel by the brain

Ketone acids (ketones) are buffered in normal patient so blood does not become acidotic

When diabetes causes extreme hyperglycaemic ketosis, this results in a metabolic acidosis that is life-threatening

Question 5

Investigations in DKA

Answer 5

Hyperglycaemia(i.e. blood glucose >11 mmol/l)

Ketosis(i.e. blood ketones > 3 mmol/l)

Acidosis(i.e. pH < 7.3)

Question 6

Management of DKA

Answer 6

Correctdehydration evenlyover 48 hrs - this will correct the dehydration and dilute thehyperglycaemiaand theketones

Give a fixed rate insulin infusion - this allows cells to start using glucose again, which in turn switches off the production of ketones.

Question 7

Why do we correct dehydration in DKA over 48 hours?

Answer 7

Correcting it faster increases the risk of cerebral oedema

Question 8

Complications of DKA

Answer 8

Cerebral oedema if corrected too quickly

Question 9

Management of cerebral oedema

Answer 9

Slow IVfluids

IVmannitol

IVhypertonic saline

Question 10

Symptoms of cerebral oedema in DKA patients

Answer 10

Headaches

Altered behaviour

Bradycardia

Changes in consciousness