DKA

Question 1

what are some early signs of DKA ?

Answer 1

feeling very thirsty
urinating often
high glucose level
high ketone level in urine

Question 2

what are some later extreme signs for DKA ?

Answer 2

feeling weak/ constantly sleepy 
dry/ flushed skin 
nausea vomitting and pain in abdomen 
difficulty in breathing 
fruity smelling breath

Question 3

what are the 3 things used to diagnose DKA ?

Answer 3

1. hyperglycemia
2. anion gap metabolic acidosis, more than 10
3. ketonemia (presence of ketones)

Question 4

what is ketone broken down into?

Answer 4

beta hydroxybutyrate and acetoacetate

Question 5

what are some precipitating factors of DKA ?

Answer 5

1. infection (30%-50%)

2. discontinuation or inadequate insulin therapy

Question 6

what are some management of DKA ?

Answer 6

provision of fluid (restore dehydration)
provision of insulin (stop over production of ketones)
replace electrolyte deficits
treat any underlying precipitating cause
monitor any complications

Question 7

what is the goal for fluid replacement for DKA ?

Answer 7

1. expansion of intravascular, interstitial and intracellular volume
2. ensure sufficient renal perfusion

Question 8

what is one thing to take note when replacing fluids in the body?

Answer 8

patient with renal or cardiac compromise need to be monitored closely to prevent fluid overload

Question 9

if there is severe hypovolemia ? what to do?

Answer 9

administer 0.9% Nacl 1 litre in an hour

Question 10

what to do when there is mild dehydration?

Answer 10

first check the Na level

Question 11

IF Na level is high- nomral what to do?

Answer 11

0.45% Nacl (200-500ml) in an hour

Question 12

what to do when serum level is low?

Answer 12

0.9% NAcal (250-500ml ) in an hour

Question 13

what is the ideal potassium level to keep for patients ?

Answer 13

4-5

usually added even though it is within the level

Question 14

what to do when potassium level is less than 3.3 ?

Answer 14

hold insulin and give 20-300

until K is more than 3.3

Question 15

what to do when K is 3.3-5.2 ?

Answer 15

give 20-30 in each liter of IV to keep serum K between 4-5

Question 16

what to do if K is more than 5.2?

Answer 16

do not give K, but check serum K every2 hours

Question 17

what is the role of insulin for DKA?

Answer 17

inhibit ketogenesis

correct hyperglycemia

Question 18

what is he choice of insulin used for dka?

Answer 18

rapid, regular insulin

Question 19

what is the prefered route for insulin for patient with DKA ?

Answer 19

continuous Iv infusion (faster onset

Question 20

what to do when first administer insulin?

Answer 20

administer IV as bolus

Question 21

if serum glucose does not fall by at least 10% in first hour what to do?

Answer 21

give 0.14 as iv bolus than continue

Question 22

once serum level of glucose reaches 11 for dka after administering insulin what to do?

Answer 22

reduce rate of IVinsulin

consider adding dextrose 5%

Question 23

once serum level of glucose reaches 16.5 for hhsafter administering insulin what to do?

Answer 23

reduce dose of insulin

add dextrose 5%

Question 24

when to stop IV insulin

Answer 24

until hyperglycemia crisis is resolved
1. blood glucose is 11

and any two of these

2. serum bicarbonate more than or equal to 15
3. ph more than 7.3
4. anion gap less than or equal to 12

Question 25

what to do when after iv insulin is stopped ?

Answer 25

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

Question 26

what to take note when changing to sc insulin?

Answer 26

need to overlap with 1-2 hours to prevent reoccurrence of hyperglycemia or ketoacidosis
s/c takes time to be reabsorbed

Question 27

while on iv insulin , when to measure blood glucose?

Answer 27

every hourly

Question 28

what to do once acute issue is resolved?

Answer 28

continue basal insulin
restart metformin
retard dapagliflozin after uti is treated

Question 29

what is hypertensive urgency defined as?

Answer 29

systolic 180

diastolic 120

Question 30

considering using ACE inhibitor to lower blood pressure

Answer 30

captopril

may cause kidney injury

Question 31

consider using alpha 1 blocker to reduce high bp

Answer 31

terazosin

Question 32

if patient have fluid retention and diabetes what medication to use?

Answer 32

loop diuretics : furosemide (may not help with bp)

add on hydrochlorthiazide and aldosterone