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A-vin Night > DKA > Flashcards

DKA Flashcards

1
Q

DKA is ALWAYS due to an underlying cause . T/F

A

FALSE

Not always but OFTEN TIMES

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2
Q

All DKA cases should have URINE CULTURE performed. T/F

A

TRUE

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3
Q

Why is AXR,CXR and AUS recommended as part of diagnostics in cases of DKA?

A

To r/o CHF, Pneumonia, Cancer, Pancreatitis

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4
Q

What if client declines diagnostics?

A

Tell the client that we might not be able to control the disease even with insulin especially if there is an underlying cause such as neoplasia

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5
Q

What to tell about prognosis to the clients.

A

~ 1/3 die or are PT

MULTIPLE days of hospitalization is needed

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6
Q

Why is central line recommended in cases of DKA?

A

As we have to draw blood multiple times on daily basis for testing

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7
Q

First step as a part of Rx for DKA patient is INSULIN. T/F

A

FALSE

  • 1st step is IV fluids
    • Insulin should be postponed until 2-6 hr after admission
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8
Q

How long after admission is insulin therapy considered.

A

2-6 hr

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9
Q

Regular insulin is used initially for Rx of DKA and best way is CRI IV. T/F

A

T

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10
Q

Dose of regular insulin CRI in:
Dogs
Cats

A

Dogs: 2 U/kg/d
Cats: 1 U/kg/d

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11
Q

Aim for glucose drop is ___ mg/dl per hour once insulin is started

A

75

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12
Q

How to prepare for R insulin for CRI

A

Add 2 U/kg in dogs and 1 U/kg in Cats to 0.9% 250 ml NaCl

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13
Q

Dose of INSULIN CRI in ml/hr based on BG?

A

> 250 → 10 ml/hr
200-250 → 7 ml/hr

100-150→ 5 ml/hr
<100 → D/C

Give 2.5% dextrose to IV fluids(separate from the insulin CRI- 0.9% NaCl mixture) if BG between 250-150 (Give 5% dextrose if < 150 )

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14
Q

when making INSULIN CRI, first ____ ml should be run via drip set and discarded

A

50 Ml

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15
Q

Shelf life of Insulin CRI

A

24 hr only

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16
Q

When to switch to longer acting insulin?

A

Once pet is EATING*, HYDRATED and ACIDOSIS** has resolved

  • can be 1-7 d
    • ketones might still be present
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17
Q

Options for Longer acting insulin in dogs and cats once they start EATING.

A

Dog : NPH , Vetsulin
Cat: Glargine

RaS NaL GuP

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18
Q

How frequently to monitor BG in cases of DKA?

A

Q2-4h

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19
Q

Do we need antibiotics in cases of DKA?

A

Yes, they are recommended in ALL CASES as per author

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20
Q

Author’s choice fo antibiotic in cases of DKA and its dose.

A

UNASYN

22 mg/kg IV q8h

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21
Q

How to reconstitute UNASYN?

A

1.5 gm vial in 50 ml NaCl
3 gm vial in 100 ml NaCl

it would be 30 mg/ml

dose is Lb/3

22
Q

Memorise dose of Unasyn(30 mg/ml)?

A

BW in POUNDS/3

For cefazolin(100 mg/ml) it is LBS/10

**Dose for both Cefazolin and Unasyn is 22 mg/kg

23
Q

Acid base status and electrolytes should be checked how often?

A

Q6-24h

** Also Check PHOSPHORUS (P and K will drop once insulin is started )

24
Q

P and K will drop once insulin is started. T/F

A

T

Thats why it is recommended to check P levels q6-24 h as low P → hemolysis especially in cats

25
Q

If P gets < ___ mg/dl, then it can cause HEMOLYSIS , especially in CATS

A

1.5

26
Q

How to avoid PHOSPHORUS from getting too low.

A

Start KPO4 supplement once level is < 2.5 mg/dl IF pet is on INSULIN .

27
Q

Basic diagnostics needed in all cases for DKA?

A

CBC/Chem

UA/UC

28
Q

What if you cannot get urine sample and you suspect DKA ?

A

Use SERUM or URINE STRIP to check for KETONES

If negative, then add one drop of urine/serum + H2O2 to confirm that no ketones

29
Q

Lets say that a suspected DKA pet is hypotensive and is hypothermic. What should be your goal?

A
  • Resuscitate to bring SAP to 90-100 mg/hg
  • Heat to bring temp atleast > 99 F

** then calculate fluid requirement

30
Q

formula to calculate dehydration in ml

A

= dehydration % X BW in kgs X 10

31
Q

In how much time should you replace the dehydration?

A

6-12 h if not hyperosmolar

12-24 h if hyperosmolar

32
Q

Do pets with DKA need K supplementation if initial K levels are normal?

A

YES

Start even if K is normal

33
Q

Monitor glucose q2h to start to keep glucose > ____ mg/dl during first 4-6 hr of treatment

A

250

** once it is lowered, goal is to keep it between 80-180 with insulin being administered

34
Q

Goal is to keep insulin between ___ and ___ while insulin is administered

A

80-180

35
Q

Longer acting insulin can be started even if ketones are present. T/F

A

T

KETONES might be present but ACIDOSIS should be resolved

36
Q

3 criteria for considering GLARGINE PROTOCOL for cats over R INSULIN CRI?

A
  • Cannot get central line
  • $$ issues
  • Very low POTTASIUM
37
Q

Formula to adjust glucose levels when checking on glucometer if VERY ANEMIC or HEMOCONCENTRATED

A

= Glucose + [(1.17 X PCV) - 50.2]

38
Q

When do we need to check MAGNESIUM?

A

Not necessary on admit but check WITHIN 8 hours of starting insulin

39
Q

-

A
  • if total Mg < 1.2 mg/dl

- if Hypokalemia or Hypocalcemia refractory to supplementation

40
Q

Frequency of giving UNASYN?

A

THREE TIMES A DAY

41
Q

Nutritional support is necessary, especially if concurrent hepatic lipidosis. T/F

A

T

Such as NE tube, Esophagostomy tube, PPN

42
Q

It is said that look for underlying cause in cases of DKA as diabetics become ketotic for a second reason. So how do you do that?

A

Urine culture
AUS
XRAY(AXR,CXR)

43
Q

Elaborate GLARGINE insulin protocol?

A

Use Glargine 0.25 U/kg BID SQ instead of insulin CRI

44
Q

Long term Glargine dose for cats ?

A

1-2 U/Cat

Consider starting before turning off insulin CRI if glucose continues to be high

45
Q

Dose fo NPH or Novolin N for dogs ?

A

0.5 U/kg BID

Turn off CRI 4 hours before start

46
Q

2 things to warn owner if initial BG is >600

A
  • prognosis is more guarded

- Neuro signs can develop

47
Q

If BG is >600, goal is to drop BG by ____ mg/dl per hour or less

A

50

48
Q

In cases with BG >600, and BG is dropping too quickly then what to do ?

  • if not on insulin?
  • if on insulin?
A
  • if not on insulin : don’t start yet or start at 1/4th or 1/3rd of calculated dose
  • if on insulin: slow it or stop it

Can also consider dextrose in fluids to slow down the drop

49
Q

K value : 3.6-5 mEq/L

Amount to add to fluids?
Max fluid rate ?

A
  • 20 mEq/L

- 26 ml/kg/hr

50
Q

K value : 3.2-3.6 mEq/L

Amount to add to fluids?
Max fluid rate ?

A
  • 40 mEq/L

- 12 ml/kg/hr

51
Q

K value : 2.8-3.2 mEq/L

Amount to add to fluids?
Max fluid rate ?

A
  • 60 mEq/L

- 9 ml/kg/hr

52
Q

K value : <2.8 mEq/L

Amount to add to fluids?
Max fluid rate ?

A

Calculate 0.5 mEq/kg/hr and give for 1-2 hr , then check K+ levels and make sure the levels reach 2.5 (then add 60-80mEq/L)

ALWAYS DILUTE

A-vin Night (9 decks)

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