DKA Flashcards

1
Q

Complications of DKA related to acute disease (4)

A
  1. Loss of airway
  2. Sepsis
  3. Myocardial infarction
  4. Hypovolemic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Complications of DKA related to therapy (5)

A
  1. Hypokalemia
  2. Hypophosphatemia
  3. ARDS
  4. Cerebral edema
  5. Hypoglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Later complications of DKA (4)

A
  1. Recurrent anion gap metabolic acidosis
  2. Non-Anion gap metabolic acidosis
  3. Vascular thrombosis
  4. Mucormycosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Best practice to prevent cerebral edema in DKA treatment (5)

A
  1. Slow reduction of osmolality during treatment
  2. Avoid large volumes of hypotonic fluid
  3. Drop blood glucose slowly during treatment
  4. Do not allow plasma Na to fall during treatment
  5. Avoid hypoxia, hypoK, PO4, Mg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Goal for glucose decrease in DKA

A

50-75mg/dl/hr

Add dextrose when glucose <250mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Essential before initiating insulin therapy

A

Initial potassium

Adequate urine output

check elecs q2; sugar q1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Requires ICU admission

A

AG >25
Glucose >800
with significant comorbidity

AG< 25, Gluvose <800 or <600 may be admitted on floors or diabetic unit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do you do when glucose does not decrease by 10% after one hour of insulin therapy?

A

0.14U/kg bolus then resume rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Active goals in DKA (5)

A
  1. Adequate fluid infusion
  2. Insulin infusion
  3. Maintain K 3.3-5.2
  4. Lower glucose by 75mg/dl/hr
  5. Maintain adequate electrolytes (Ca, Mg, Phos)

When glucose approaches 200mg/dl, shift IV to D51/2NS with 20-40meq KCL/L; decrese insulin rate to 0.02 to 0.05u/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cellular starvation brought about by insulin deficiency and catabolic hormone excess

A

DKA

Counterregulatory hormones: glucagon (primary), catecholamines, cortisol, growth hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Primary ketone bodies

A

B-hydroxybutyrate
Acetoacetic acid

AcAc + NADH <–> BHB + NAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features in DKA are directly related to? (3)

A
  1. Hyperglycemia
  2. Volume depletion
  3. Acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Altered mental status in DKA better correlates with?

A

Elevated serum osmolality >320mosm/L or >320mmol/kg

better correlation vs acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Parameters to diagnose DKA

A
  1. Blood glucose >250mg/dl
  2. AG >10-12
  3. HCO3 <15mEq/L
  4. pH <7.3
  5. Ketonemia or ketonuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mild DKA

A

pH: 7.25-7.30
HCO3: 15-18
AG: >10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Moderate DKA

A

pH: 7.0-7.24
HCO3: 10-15
AG: >12

17
Q

Severe DKA

A

pH: <7.0
HCO3: <10
AG: >12
(+) stuporous

18
Q

Euglycemic DKA

A

BG <250mg/dl
Serum BHB >3mEq/L

Pregnant, T1DM, Vomiting, Alcohol abuse, LIver failure, Starvation, Arrived after receiving insulin, impaired glulconeognesis, depression, SGLT 2 inhibitors

19
Q

At risk for developing type B (aerobic) lactic acidosis

A

metformin intake + new-onset renal insufficiency

20
Q

What drugs can cause false (+) urine ketones

detected by nitroprusside

A

Sulfa drugs
ACEi (captopril)

Nitroprusside reagent detects AcAc
during treatment BHB is converted back to AcAC thus increasing K detected in urine

21
Q

Venous pH is lower than arterial pH by how much?

A

0.03

22
Q

Potassium is usually depleted by renal losses. However, measured potassium is usually _____ or _____ due to?

A

normal or elevated

due to:
1. extracellular shift sec to acidemia
2. Increased intravascular osmolarity secondary to hyperglycemia

23
Q

Decrease in serum potassium during therapy is reported to be?

A

1.5mEq/L or 1.5mmol/L

24
Q

For every 100mg/dl of glucose above 100mg/dl, ___ is added to serum Na

what is the factor if glucose is above 400mg/dl?

Hyperglycemia tends to artificially lower serum sodium levels

A

1.6 mEqs

2.4 mEqs

25
Q

Creatinine elevation is due to

A

Pre renal azotemia
Factitious elevation by interaction with nitroprusside assay