DKA Flashcards
How does DKA present
Hyperglycaemia
Dehydration
Ketosis
Metabolic acidosis (with a low bicarbonate)
Potassium imbalance
What symptoms will the patient have
Polyuria
Polydipsia
Nausea and vomiting
Acetone smell to their breath
Dehydration and subsequent hypotension
Altered Consciousness
They may have symptoms of an underlying trigger (i.e. sepsis)
What is the priority during management
the priority is fluid resuscitation to correct the dehydration, electrolyte disturbance and acidosis.This is followed by an insulin infusion to get the cells to start taking up and using glucose and stop producing ketones.
What is the diagnosis for DKA
Hyperglycaemia (i.e. blood glucose > 11 mmol/l)
Ketosis (i.e. blood ketones > 3 mmol/l)
Acidosis (i.e. pH < 7.3)
What is the mnemonic for DKA treatment
FIG-PICK fluids, insulin, glucose, potassium, infection, chart, ketones
What should be done with fluids
IV fluid resuscitation with normal saline (e.g. 1 litre stat, then 4 litres with added potassium over the next 12 hours)
What should we monitor
G – Glucose – Closely monitor blood glucose and add a dextrose infusion if below a certain level (e.g. 14 mmol/l)
P – Potassium – Closely monitor serum potassium (e.g. 4 hourly) and correct as required
K – Ketones – Monitor blood ketones (or bicarbonate if ketone monitoring is unavailable)
What should be done prior to stopping insulin and fluid infusion
Establish the patient on their normal subcutaneous insulin
What rate should potassium be infused at
should not be infused at a rate of more than 10 mmol per hour.
What happens in Ketoacidosis
patient gets higher and higher glucose and ketones levels. Initially the kidneys produce bicarbonate to counteract the ketone acids in the blood and maintain a normal pH. Over time the ketone acids use up the bicarbonate and the blood starts to become acidic. This is called ketoacidosis.
Why does ketoacidosis happen
Not have enough insulin to use and process glucose therefore ketogenesis occurs
