DKA Flashcards
What is pathogensis of DKA
Lipolysis due insulin deficinecy causes of free fatty acids in blood and causes ketone bodies and keto acidosis occur
What is anion gap
It is + to -
Balancin ratio of body normally 8-12
Ag= Na -[Cl+HCO3]
What are preciptants of DKa
Insulin deficiency
Intoxicaion: alcohol and drugs
Iatrogenic: glucocorticoid
Infarction: MI and Chf
Inflammation: Pancreatitis
Infection: UTI
Clinical Features of DKA
Symptoms:
Polyuria, polydipsia, dehydration, wieghtloss, nausea, vomitting, abdominal pain, weakness
Signs of DKA
tachycardia
Kussmual breathing
Cold extremities
Hypothermia
Hypotension
Coma
Confusion
What are the diagnostic test of DKA?
6
RBS
Ketoacids in blood
Urea and creatinine
Serum Elctrolytes
ABGs
CBC
ECG
What is principles of management?
fluid replacment
Short acting
Potasium replacment
Prophylatic antibiotics
Short acting insulin regimen?
10Units i.v bolus insulin following by 0.1u/kg/hour
When anion gap is normal then start subcutanous insulin along with 30 mints of iv insulin
Why 30 mints of i.v insulin?
Due to prevention of rebound hyperglycemic attacks and ketoacidosis
`Fluid replacement regimen
Normal saline 1-3 L in 1 hour
Normal saline 1L ( over following 1 hour)
Normal saline 1L ( over following 2 hour)
Normal saline 1L ( over following 4 hour)
Potassium replacement
In DKA pt may have hyperkalemia but overall potassium of body is low
Potassium regimen
If serum K is >5.5 = no replacement
If K is <5.5
Start K replacement
Add 20-40 mEq/L of KCL to each litre of fliud once is <5.5
If a patient serum K is <3.5
It is avisable not start IV insulin, unless K replacement is underway
B/c insulin promotes entry of K in cells
It increase risk of life threatening arrhythmias
HHS
It is metabolic emergeny of uncontrolled type 2 DM
Clinical features of hhs
Dehhydration,stupor,coma
Precipitating factors are same of DKA but also included dehydration and renal failure
Diagnosis of hhs
Hyperglycemia (>600mg/dl)
Inc serum osmality
No ketoacidosis
Altered mental status
