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Childs Health > DKA > Flashcards

DKA Flashcards

1
Q

Biochemical crtieria

A

> 11 glucose
venous pH < 7.3 OR bicarb >15
Ketonaemia >3

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2
Q

Risk factors DKA

A

<2 years - new diagnosed
Delay diagnosis
Insulin omission
Poor metabolic control
Prev episodes DKA
GE with persistent vomitting
Eating disorder - diabulimia
Challening social and family circumstanced
Adolescents
Pump therapy

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3
Q

What type of insulin is given in pump therapy?

A

Short acting insulin

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4
Q

Mild DKA parameters

A

mild - pH <7.3, <15mmol bicarb

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5
Q

Severity of DKA?

A

mild - pH <7.3, <15mmol bicarb

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6
Q

Moderate DKA severity

A

pH<7.2, bicarb >10

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7
Q

Severe DKA severiy

A

pH < 7.1, bicarb >15

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8
Q

Counterregulatory hormones to insulni

A

Glucagon
Cortisol
Growth hormone
Catecholamines

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9
Q

Aseess for in DKA

A

GCS
BP, pulse, CRT
Degree of dehydration
Acidotic respiration
Vomitting
BG, ketones, blood gas, U/E, FBC, cultures
Suspect sepsis if fever or hypothemia, hypotension, refractory acidosis or lactic acidosis

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10
Q

What does hypotnesion in DKA signa;?

A

Cerebral oedema

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11
Q

Clinical signs and symptoms DKA

A

Dehydration
Tachycardia/ypnoea
N+V
Deep, sighing resp
Semll acetone
Abdo pain
Confusion

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12
Q

Goals of therapy

A

Cprrect dehydration
Correct acidosis and reverse ketosis
Slowly correct hyper-osmolay
Restore BG to near normak
Monitor complications of DKA and its treatment
Identify and treat and precipitating event

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13
Q

When insert AW in DKA

A

When child camatose

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14
Q

When insert NG tube

A
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15
Q

Why monitor T waves in DKA?

A

Hyperkalemia - tall tented

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16
Q

What is a late sign of cerebral oedema?

A

Papilloedema

17
Q

Treatment DKA

A

10mls/kg blus over 30 mins
Sec 10ml/kg bolus and reassess may need second
Insulin at 0.05 units/kg/hr
Continue basal insulin
Max weight 75kg/98th percentile for age

18
Q

Segar Holliday formula

A

Child fluid allowance

19
Q

What do with pump therapy in DKA?

A

STOP - short acting insulinn

20
Q

When consider reducing insulin in KDA?

A

BG < 14

21
Q

otassium level in forst 24 hours

A

Over 5.5 - nil
3.5-5.5
Under 3.5 - central line anaaesthetist high concentration

22
Q

Insulin has aldosterone effect

A

Pushes potassium into cell

23
Q

Treatement expectation of DKA

A

Reduction of blood ketone concentation at least 0.5mmol/L/hr
Bicarb rise by 3mmol/l/hr
Cap blood glucose falls by 3mmol/L/hr
Na+ corrects by 4-5 mmol/L/he

24
Q

What monitor in DKA

A

Headahce
Innapropriate slwoing HR
Recurrnec of vomitting
Change in neurological status - restlessness, irritability, increased drwosy, incontinence
Specific neurological signs - cn palsies, abnormal pupillary repsosne

25
Q

If acidosis is not correctin

A

Insiffucient insulin to switch off ketones
inadequate resuscitation
Sepsis
Hypercholoramic acidosis - drop saline conc
Slaicyclate or other perscription or recreational drugs

26
Q

Hypoglycaemia cut off in neonates

A

2.6

27
Q

If BG <4 what do you use

A

10% dextrose 2mls/kg bolus
Reduce insulin

28
Q

Hypoglycaemia in normal child

A

3.6

29
Q

What is hypoglycaemia in child with diabetes

A

4

30
Q

Complications DKA

A

Cerebral oedema
Hypo
Hypokalemia
Sepsis
Myoglobinuria
Spiaration oneumonai
Thrombosis
Pancereatitis

31
Q

Patient risk factors for hypoglycaemia?

A

Hypoglycaemia unawareness
History of previous hypos
Defective glucose counterregulation
Long duration of diabetes
Erratic insulin absorption
<5-7 years

32
Q

Behavioural risk factors for hypoglycaemia

A

Dietary inconsistency
Prlonged fasting
Missed meal or snack
Strenous exercise - also increases sesntiivtity to insulin

33
Q

Medical risk factors for hypoglycaemia

A

Drug side effects - beta blockers (block signs of hypos)
Dosing errors
Unpredicatable insulin kinetics
Inappropriate insulin distribution

34
Q

Autonomic symtpoms of hypoglycaemia

A

Hunger
Swaeting and clammy hands
Anxiety
Pallor
Nausea
Trembling or shaking

35
Q

Neuroglycopenia symptoms of hypoglycaemia

A

Dizziness/confusion
Headache/irritability
Blurred/bright vision
Slurred speech
Sleep/gazed eyes
Weakness
Lack of concentration
Feeling warm or hot
Naughty/aggressive behaviour
Nightmares/seizures

36
Q

Risk factors at diagnosis or during treatment of DKA for more severe presentation

A

Greater hypocapnia at presentation
Increased urea at presentataion
More severe acidosis at presentation
A marked early decrease in serum effective osmolality
Attenuated rise in serum sodium conc or early fall in glucose-corrected sodium during therapy
Greater volumes of fluid in first 4 hours
Administration of insulin in first hour of fluid

37
Q

Features of cerebral oedema

A

Abnormal motor or verbal response to pain
Decorticate or decerebrate posture
Cranial nerve palsy (III, IV, VI)
Abnormal neurogenic resp pattern

38
Q

Abnormal neurogenic respiration in cerebral oedema features

A

High RR
Grunting
Cheyne-Stokes breathing
Apnoeas

39
Q

Neuroprotective measures

A

Elevate head 30 degrees
Intubation if impending resp failure
Maintain BP + tmep
CO2 low end of nomrla
Consider crainial imaging

Childs Health (82 decks)

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