DKA

Question 1

DKA triad (HKA)

Answer 1

Hyperglycaemia over 11mmol/L
Acidosis below 15mmol/L or venous pH less than 7.3
Ketonaemia: 3mmol/L and over

Question 2

DKA: precipitating factors

Answer 2

infection, dehydration, fasting, or the first presentation of Type 1 diabetes.

Question 3

DKA investigations

Answer 3

Bloods - ketones + BG
- U&Es to check renal function + electrolyte imbalance –> ECG

ABG - acidosis

If infection - cultures

Question 4

DKA management

Answer 4

If patient is alert, not significantly dehydrated and able to tolerate oral intake without vomiting –> encourage oral intake and give subcutaneous insulin injection

If patient is vomiting, confused, or significantly dehydrated –> give IV fluids (initial bolus of 10mls/kg 0.9% NaCl then discuss with senior) + insulin infusion at 0.1 units/kg/hour 1hr after starting IV fluids. If there is evidence of shock, the initial bolus should be 20mls/kg.

If patient is shocked or comatose –> ABCDE approach for emergency resuscitation

Do not stop intravenous insulin infusion until 1 hour after subcutaneous insulin has been given.

Question 5

Complication of DKA

Answer 5

cerebral oedema
–> slow IV fluid over 48hrs