DKA

Question 1

DIABETES KETO ACIDOSIS

Answer 1

It is a diabetic complication and Emergency characterized by Hyperglycemia of >250MG/DL and Metabolic acidosis due to ketone accumulation in blood.
- Most common in patients with type 1 diabetes than type 2.

In diabetic ketoacidosis patients present with moderate-to-high blood glucose levels together with water and electrolyte depletion. This is because, when hyperglycaemia occurs and is sustained, osmotic diuresis occurs resulting in water and electrolyte excretion.

Question 2

Signs and symptoms:

Answer 2

Signs and symptoms:
 Hyperglycaemia (consistently elevated blood glucose),
 Thirst,
 Excessive urination,
 Fatigue,
 Blurred vision,
 Fruity breath odour,
 Deep and difficult breathing,
 Dehydration (dry mouth, dry skin),  Nausea & vomiting,
 Stomach pains and loss of appetite.

Question 3

PRECIPITANTS

Answer 3

PRECIPITANTS
- Infections; pneumonia, UTIs, pancreatitis, burns
- New diagnosis
- Non-adherent to Medication
- Drugs; thiazide, beta blockers, glucocorticoids, atypical anti psychotics etc.
- Inadequate insulin dosing
- Conditions; depression, stress, stroke etc.

Question 4

LAB PARAMETERS

Answer 4

LAB PARAMETERS
- Hyperglycemia >14mmol/l (250mgdl)
- Ketones (beta hydroxybutarate, acetoacetate and acetone) beta hydroxybutarate level of
more 0.6mmol/l
- Acidosis (serum bicarbonate <18mmol/l and arterial PH < 7.3)
- Arterial blood gases >10mEq

Question 5

TREATMENT PROTOCOLS

Answer 5

TREATMENT PROTOCOLS
 Treatment involves a 5order protocol
- Fluid resuscitation
- Insulin therapy
- Electrolyte correction
- Acid/base balance
- Treatment of current infection

 Fluid replacement: use 0.9% normal saline
 Insulin: continuous intravenous infusion of insulin and monitor blood glucose level
 Electrolytes:potassiumsupplementationisstartedonceelevatedpotassiumlevelsbegin
to drop and good urine outflow is achieved. In acidosis, serum potassium level may be high initially.

Question 6

Patient monitoring

Answer 6

Patient monitoring
 Blood pressure monitoring
 HbA1c (glycated haemoglobin) 6.5–7.5%: provides an indication of glycaemic control
over the previous 3 months.
 Blood glucose levels
 Lipid profile & body weight

Question 7

Drugs that should be considered in diabetics to reduce cardiovascular risk include:

Answer 7

 ACE inhibitors
 Aspirin
 Lipid-regulating drugs.

Question 8

Hypoglycaemia may develop in:

Answer 8

 Insulin overdosage
 Increased work or exercise  Omission or delay of a meal  Vomiting & diarrhoea.

Question 9

Insulin dosages needs to be changed often over the lifetime. For example:

Answer 9

 Changes in weight,
 Food intake,
 Health conditions (pregnancy, infection),
 Activity level and work
These can affect the amount of insulin needed to control the blood sugar