DKA Flashcards
what are some early signs of DKA ?
feeling very thirsty
urinating often
high glucose level
high ketone level in urine
what are some later extreme signs for DKA ?
feeling weak/ constantly sleepy dry/ flushed skin nausea vomitting and pain in abdomen difficulty in breathing fruity smelling breath
what are the 3 things used to diagnose DKA ?
- hyperglycemia
- anion gap metabolic acidosis, more than 10
- ketonemia (presence of ketones)
what is ketone broken down into?
beta hydroxybutyrate and acetoacetate
what are some precipitating factors of DKA ?
- infection (30%-50%)
2. discontinuation or inadequate insulin therapy
what are some management of DKA ?
provision of fluid (restore dehydration)
provision of insulin (stop over production of ketones)
replace electrolyte deficits
treat any underlying precipitating cause
monitor any complications
what is the goal for fluid replacement for DKA ?
- expansion of intravascular, interstitial and intracellular volume
- ensure sufficient renal perfusion
what is one thing to take note when replacing fluids in the body?
patient with renal or cardiac compromise need to be monitored closely to prevent fluid overload
if there is severe hypovolemia ? what to do?
administer 0.9% Nacl 1 litre in an hour
what to do when there is mild dehydration?
first check the Na level
IF Na level is high- nomral what to do?
0.45% Nacl (200-500ml) in an hour
what to do when serum level is low?
0.9% NAcal (250-500ml ) in an hour
what is the ideal potassium level to keep for patients ?
4-5
usually added even though it is within the level
what to do when potassium level is less than 3.3 ?
hold insulin and give 20-300
until K is more than 3.3
what to do when K is 3.3-5.2 ?
give 20-30 in each liter of IV to keep serum K between 4-5
what to do if K is more than 5.2?
do not give K, but check serum K every2 hours
what is the role of insulin for DKA?
inhibit ketogenesis
correct hyperglycemia
what is he choice of insulin used for dka?
rapid, regular insulin
what is the prefered route for insulin for patient with DKA ?
continuous Iv infusion (faster onset
what to do when first administer insulin?
administer IV as bolus
if serum glucose does not fall by at least 10% in first hour what to do?
give 0.14 as iv bolus than continue
once serum level of glucose reaches 11 for dka after administering insulin what to do?
reduce rate of IVinsulin
consider adding dextrose 5%
once serum level of glucose reaches 16.5 for hhsafter administering insulin what to do?
reduce dose of insulin
add dextrose 5%
when to stop IV insulin
until hyperglycemia crisis is resolved
1. blood glucose is 11
and any two of these
- serum bicarbonate more than or equal to 15
- ph more than 7.3
- anion gap less than or equal to 12
what to do when after iv insulin is stopped ?
convert iv insulin to SC basal insulin (insulartard glagine)
if on insulin before admission
- restart insulin dosage
if not on insulin
- use 80% of the iv insulin requirement over 24 hours from where the blood glucose stabalise
what to take note when changing to sc insulin?
need to overlap with 1-2 hours to prevent reoccurrence of hyperglycemia or ketoacidosis
s/c takes time to be reabsorbed
while on iv insulin , when to measure blood glucose?
every hourly
what to do once acute issue is resolved?
continue basal insulin
restart metformin
retard dapagliflozin after uti is treated
what is hypertensive urgency defined as?
systolic 180
diastolic 120
considering using ACE inhibitor to lower blood pressure
captopril
may cause kidney injury
consider using alpha 1 blocker to reduce high bp
terazosin
if patient have fluid retention and diabetes what medication to use?
loop diuretics : furosemide (may not help with bp)
add on hydrochlorthiazide and aldosterone
