DKA

Question 1

How does DKA present?

Answer 1

Polyuria
Polydipsia
Dehydration
Weight loss
Nausea and vomiting
Acetone smell to breath
Altered consciousness

Question 2

How would you initially manage a patient presenting with DKA?

Answer 2

ABCDE
High flow oxygen
IV fluids
Observations

Question 3

What investigations are used to diagnose DKA?

Answer 3

Blood glucose and ketones

Venous blood gas
U&E

Question 4

What fluid would you give immediately to a patient in DKA?

Answer 4

10ml/kg 0.9% sodium chloride solution over 1 hour

Question 5

What fluid would you immediately give to a patient in DKA with shock?

Answer 5

20ml/kg 0.9% sodium chloride solution over 15 minutes

Question 6

What fluids are given over 48 hours to a patient in DKA?

Answer 6

Immediate fluid resuscitation
Fluid replacement for dehydration
Maintenance fluid

Question 7

What electrolyte should be given with fluids in DKA?

Answer 7

Potassium

Question 8

How should insulin be used in DKA?

Answer 8

Insulin should be given at a rate of 0.1 units/kg/hour in children

Question 9

What are the fasting, pre-meal and post-meal glucose targets in children?

Answer 9

Fasting- 4-7 mmol/L
Pre-meal - 4-7 mmol/L
Post-meal - 5-9 mmol/L

Question 10

Why is potassium given in DKA?

Answer 10

Insulin drives potassium into cells, so potassium is given to prevent hypokalaemia

Question 11

What two other conditions are children screened for when diabetes is suspected?

Answer 11

Coeliac disease
Thyroid disease

Question 12

What are the criteria for diagnosis of DKA?

Answer 12

Hyperglycaemia > 11mmol/L
Ketosis > 3mmol/L
Acidosis - pH < 7.3

Question 13

What is the main complication of DKA?

Answer 13

Cerebral oedema