DKA

Question 1

What is DKA?

Answer 1

A medical emergency characterised by hyperglycaemia, acidosis and ketonaemia

Question 2

What situations does DKA commonly present in?

Answer 2

Initial presentation of T1DM
An existing diabetic who is unwell
An existing diabetic who is not adhering to insulin regime

Question 3

What is the presentation of DKA?

Answer 3

Polyuria
Polydipsia
Nausea and vomiting
Acetone smell to breath
Dehydration
Weight loss
Hypotension
Altered consciousness
Kussmaul respiration (deep hyperventilation)

Question 4

What is the pathophysiology of DKA?

Answer 4

A net reduction in insulin leads to reduced entry of glucose into cells

Lipids are metabolised as an alternative energy source, which leads to elevated free fatty acids and ketones

Question 5

What investigations are performed in the diagnosis of DKA?

Answer 5

Urine dip - ketonuria and glycosuria
Bedside ketone and capillary glucose
ABG/VBG
U&Es
FBC and CRP

Question 6

What is the criteria for diagnosis of DKA?

Answer 6

Hyperglycaemia - >11mmol/L
Ketosis > 3mmol/L
Acidosis - pH < 7.3 and/or HCO3 < 15mmol/L

Question 7

What is the management of DKA in adults?

Answer 7

IV fluid resuscitation
Insulin
Glucose
Potassium
Treat any underlying infection
Monitor glucose, ketones, pH, bicarbonate and electrolytes

Question 8

What fluid resuscitation is given in DKA?

Answer 8

If systolic < 90 - 500ml 0.9% NaCl given over 15 minutes

If systolic > 90:
1 litre 0.9% NaCl given over 1 hour
1 litre 0.9% NaCl with KCl given over next 2 hours
1 litre 0.9% NaCl with KCl given over next 2 hours
1 litre 0.9% NaCl with KCl given over next 4 hours
1 litre 0.9% NaCl with KCl given over next 4 hours
1 litre 0.9% NaCl with KCl given over next 6 hours

Question 9

When is glucose started in DKA?

Answer 9

An infusion of 10% dextrose should be started at 125ml/hour when blood glucose is < 14 mmol/L

Question 10

What alterations are made to a patient’s regular insulin in DKA?

Answer 10

Long acting insulin is continued, short acting insulin should be stopped

Question 11

What is required for insulin and fluid to be stopped in resolving DKA?

Answer 11

Ketosis and acidosis is resolved
Patient is eating and drinking
Patient has started their regular subcut insulin (short acting insulin)

Question 12

What are the complications of treatment for DKA?

Answer 12

Hypoglycaemia
Hypokalaemia
Cerebral oedema
Pulmonary oedema secondary to fluid overload

Question 13

What are the complications of DKA?

Answer 13

Gastric stasis
Thromboembolism
Arrhythmias secondary to hyperkalaemia
AKI