DKA Flashcards
Define DKA
Increased lipolysis and increased gluconeogenesis eventually results in excess ketone levels leading to ketoacidosis.
what is the pathophysiology behind DKA
-Due to low insulin, there is unrestrained lipolysis and gluconeogenesis.
-Excess glucose is converted into ketones too if they are not used.
What does lipolysis result in?
Lipolysis results in fats broken down into fatty acids which are broken down into ketones.
what ph are ketones?
acidic
what are key features of DKA
- dehydration
- ketoacidosis
- potassium imbalance.
what are the risk factors for DKA?
- Undiagnosed T1DM
- Infection/Illness
- Being under 20 years old
-Poor Insulin compliance
What are the differential diagnosis’ for DKA?
-HHS
- Lactic Acidosis (Identical Presentation, but normal ketones and glucose)
- Starved Ketosi
what are complications of DKA
- Coma
- Cerebral oedema
- Thromboembolism
- Aspiration pneumonia
- Death
- Dehydration
- MI
What are signs of DKA?
- Fruity “Pear Drop” Breath
- Kussmaul breathing (fast, deep breaths
- Reduced Tissue Turgor
What are the symptoms for DKA?
- Polyuria
- Polydipsia
- Hyperglycaemia
- Potassium imbalance
- Weight loss
- Nausea and vomiting
- Reduced consciousness
- Acidosis
- Hypotension
- Dehydration
how is DKA diagnosed?
Requires all 3 of:
- Hyperglycaemia (blood glucose over 11mmol/l)
- Ketosis (blood ketones over 3mmol/l)
- Acidosis (pH under 7.3)
what is the treatment for DKA?
ABCDE should be followed first.
THEN:
F – Fluids – IV 0.9% Saline
I – Insulin at 0.1 units/kg/hour
G – Glucose – Add glucose IV if <14mmol/l
P – Potassium – Add Potassium to IV fluids
I – Infection – Treat underlying infection
C – Chart fluid balance
K – Ketones – Monitor ketones, pH and Bicarbonate levels
What are some complications of the treatment for DKA?
hypoglycaemia, hypokalaemia, cerebral oedema and pulmonary oedema.
Compare DKA and HHsS
DKA-
T1DM-
-Patients younger and leaner
-Ketoacidosis
- Develops over hours to a day
-HHS
- T2DM
- No ketoacidosis
- Significantly higher mortality rate
- develops over a longer time
- days to a week