DKA Flashcards
Complications of DKA related to acute disease (4)
- Loss of airway
- Sepsis
- Myocardial infarction
- Hypovolemic shock
Complications of DKA related to therapy (5)
- Hypokalemia
- Hypophosphatemia
- ARDS
- Cerebral edema
- Hypoglycemia
Later complications of DKA (4)
- Recurrent anion gap metabolic acidosis
- Non-Anion gap metabolic acidosis
- Vascular thrombosis
- Mucormycosis
Best practice to prevent cerebral edema in DKA treatment (5)
- Slow reduction of osmolality during treatment
- Avoid large volumes of hypotonic fluid
- Drop blood glucose slowly during treatment
- Do not allow plasma Na to fall during treatment
- Avoid hypoxia, hypoK, PO4, Mg
Goal for glucose decrease in DKA
50-75mg/dl/hr
Add dextrose when glucose <250mg/dl
Essential before initiating insulin therapy
Initial potassium
Adequate urine output
check elecs q2; sugar q1
Requires ICU admission
AG >25
Glucose >800
with significant comorbidity
AG< 25, Gluvose <800 or <600 may be admitted on floors or diabetic unit
What do you do when glucose does not decrease by 10% after one hour of insulin therapy?
0.14U/kg bolus then resume rate
Active goals in DKA (5)
- Adequate fluid infusion
- Insulin infusion
- Maintain K 3.3-5.2
- Lower glucose by 75mg/dl/hr
- 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
Cellular starvation brought about by insulin deficiency and catabolic hormone excess
DKA
Counterregulatory hormones: glucagon (primary), catecholamines, cortisol, growth hormone
Primary ketone bodies
B-hydroxybutyrate
Acetoacetic acid
AcAc + NADH <–> BHB + NAD
Clinical features in DKA are directly related to? (3)
- Hyperglycemia
- Volume depletion
- Acidosis
Altered mental status in DKA better correlates with?
Elevated serum osmolality >320mosm/L or >320mmol/kg
better correlation vs acidosis
Parameters to diagnose DKA
- Blood glucose >250mg/dl
- AG >10-12
- HCO3 <15mEq/L
- pH <7.3
- Ketonemia or ketonuria
Mild DKA
pH: 7.25-7.30
HCO3: 15-18
AG: >10