DKA

Question 1

What are the 3 criteria for a DKA?

Answer 1

1) Hyperglycaemia >11mmol/L

2) Ketones>3 mmol/L in blood or +2 in urine

3) Acidosis pH <7.3 or bicarb <15mmol/L

Question 2

What should ALWAYS be excluded as a cause for DKA?

Answer 2

Sepsis

Question 3

Give some causes/triggers of DKA

Answer 3

1) Poor compliance with meds (most common)

2) Infection (exclude sepsis)

3) Stress e.g. surgery, menstruation, trauma

4) Underlying acute conditions e.g. MI

Question 4

How is Na+ affected in DKA?

Answer 4

Typically hypernatraemia (due to dehydration)

Question 5

ABG results in DKA?

Answer 5

Low pCO2 with metabolic acidosis and a large negative base excess (due to production of ketones)

Question 6

What investigations are required in DKA?

Answer 6

1) FBC: infection & haemoconcentration

2) U&Es: volume status (Na+), K+ level & evaluate AKI

3) Plasma glucose & ketones

4) ABG: acid base balance & peripheral perfusion (lactate)

5) Urine dip: infection & ketones

6) ECG: arrthythmia, exclude MI

Question 7

Mx steps in DKA?

Answer 7

ALWAYS FOLLOW TRUST PROTOCOL

1) Fluid therapy:
- 1L 0.9% saline over 1hr
- 1L 0.9% saline over 2hr

2) Insulin:
- fixed rate infusion of 0.1 units/kg/hr
- continue long acting insulin, stop short acting insulin

3) Glucose:
- add 10% dextrose to fluid when blood glucose <14 mmol/L

4) Potassium:
- keep close eye on K+

Question 8

What are the treatment targets in DKA?

a) glucose
b) ketones
c) K+

Answer 8

a) reduce blood glucose by 3-5 mmol/L/hr

b) reduce ketones by 0.5 mmol/L/hr

c) maintain K+ between 4-5.5 mmol/L - likely to require IV replacement

Question 9

What are 3 possible complications of DKA?

Answer 9

1) Fluid overload: cerebral oedema, pulmonary oedema (especially in children & elderly)

2) Arrhythmia: linked to K+ (hypokalaemia from insulin)

3) VTE: blood becomes haemoconcentrated and patients become prothrombotic