DKA Flashcards
DKA is ALWAYS due to an underlying cause . T/F
FALSE
Not always but OFTEN TIMES
All DKA cases should have URINE CULTURE performed. T/F
TRUE
Why is AXR,CXR and AUS recommended as part of diagnostics in cases of DKA?
To r/o CHF, Pneumonia, Cancer, Pancreatitis
What if client declines diagnostics?
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
What to tell about prognosis to the clients.
~ 1/3 die or are PT
MULTIPLE days of hospitalization is needed
Why is central line recommended in cases of DKA?
As we have to draw blood multiple times on daily basis for testing
First step as a part of Rx for DKA patient is INSULIN. T/F
FALSE
- 1st step is IV fluids
- Insulin should be postponed until 2-6 hr after admission
How long after admission is insulin therapy considered.
2-6 hr
Regular insulin is used initially for Rx of DKA and best way is CRI IV. T/F
T
Dose of regular insulin CRI in:
Dogs
Cats
Dogs: 2 U/kg/d
Cats: 1 U/kg/d
Aim for glucose drop is ___ mg/dl per hour once insulin is started
75
How to prepare for R insulin for CRI
Add 2 U/kg in dogs and 1 U/kg in Cats to 0.9% 250 ml NaCl
Dose of INSULIN CRI in ml/hr based on BG?
> 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 )
when making INSULIN CRI, first ____ ml should be run via drip set and discarded
50 Ml
Shelf life of Insulin CRI
24 hr only
When to switch to longer acting insulin?
Once pet is EATING*, HYDRATED and ACIDOSIS** has resolved
- can be 1-7 d
- ketones might still be present
Options for Longer acting insulin in dogs and cats once they start EATING.
Dog : NPH , Vetsulin
Cat: Glargine
RaS NaL GuP
How frequently to monitor BG in cases of DKA?
Q2-4h
Do we need antibiotics in cases of DKA?
Yes, they are recommended in ALL CASES as per author
Author’s choice fo antibiotic in cases of DKA and its dose.
UNASYN
22 mg/kg IV q8h
How to reconstitute UNASYN?
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
Memorise dose of Unasyn(30 mg/ml)?
BW in POUNDS/3
For cefazolin(100 mg/ml) it is LBS/10
**Dose for both Cefazolin and Unasyn is 22 mg/kg
Acid base status and electrolytes should be checked how often?
Q6-24h
** Also Check PHOSPHORUS (P and K will drop once insulin is started )
P and K will drop once insulin is started. T/F
T
Thats why it is recommended to check P levels q6-24 h as low P → hemolysis especially in cats
If P gets < ___ mg/dl, then it can cause HEMOLYSIS , especially in CATS
1.5
How to avoid PHOSPHORUS from getting too low.
Start KPO4 supplement once level is < 2.5 mg/dl IF pet is on INSULIN .
Basic diagnostics needed in all cases for DKA?
CBC/Chem
UA/UC
What if you cannot get urine sample and you suspect DKA ?
Use SERUM or URINE STRIP to check for KETONES
If negative, then add one drop of urine/serum + H2O2 to confirm that no ketones
Lets say that a suspected DKA pet is hypotensive and is hypothermic. What should be your goal?
- Resuscitate to bring SAP to 90-100 mg/hg
- Heat to bring temp atleast > 99 F
** then calculate fluid requirement
formula to calculate dehydration in ml
= dehydration % X BW in kgs X 10
In how much time should you replace the dehydration?
6-12 h if not hyperosmolar
12-24 h if hyperosmolar
Do pets with DKA need K supplementation if initial K levels are normal?
YES
Start even if K is normal
Monitor glucose q2h to start to keep glucose > ____ mg/dl during first 4-6 hr of treatment
250
** once it is lowered, goal is to keep it between 80-180 with insulin being administered
Goal is to keep insulin between ___ and ___ while insulin is administered
80-180
Longer acting insulin can be started even if ketones are present. T/F
T
KETONES might be present but ACIDOSIS should be resolved
3 criteria for considering GLARGINE PROTOCOL for cats over R INSULIN CRI?
- Cannot get central line
- $$ issues
- Very low POTTASIUM
Formula to adjust glucose levels when checking on glucometer if VERY ANEMIC or HEMOCONCENTRATED
= Glucose + [(1.17 X PCV) - 50.2]
When do we need to check MAGNESIUM?
Not necessary on admit but check WITHIN 8 hours of starting insulin
-
- if total Mg < 1.2 mg/dl
- if Hypokalemia or Hypocalcemia refractory to supplementation
Frequency of giving UNASYN?
THREE TIMES A DAY
Nutritional support is necessary, especially if concurrent hepatic lipidosis. T/F
T
Such as NE tube, Esophagostomy tube, PPN
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?
Urine culture
AUS
XRAY(AXR,CXR)
Elaborate GLARGINE insulin protocol?
Use Glargine 0.25 U/kg BID SQ instead of insulin CRI
Long term Glargine dose for cats ?
1-2 U/Cat
Consider starting before turning off insulin CRI if glucose continues to be high
Dose fo NPH or Novolin N for dogs ?
0.5 U/kg BID
Turn off CRI 4 hours before start
2 things to warn owner if initial BG is >600
- prognosis is more guarded
- Neuro signs can develop
If BG is >600, goal is to drop BG by ____ mg/dl per hour or less
50
In cases with BG >600, and BG is dropping too quickly then what to do ?
- if not on insulin?
- if on insulin?
- 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
K value : 3.6-5 mEq/L
Amount to add to fluids?
Max fluid rate ?
- 20 mEq/L
- 26 ml/kg/hr
K value : 3.2-3.6 mEq/L
Amount to add to fluids?
Max fluid rate ?
- 40 mEq/L
- 12 ml/kg/hr
K value : 2.8-3.2 mEq/L
Amount to add to fluids?
Max fluid rate ?
- 60 mEq/L
- 9 ml/kg/hr
K value : <2.8 mEq/L
Amount to add to fluids?
Max fluid rate ?
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
