DKA

Question 1

Causes of DKA (5I’s)

Answer 1

Infection, Iatrogenic (steroids), Insulin Omission, Ischaemia, Idiopathic

Question 2

Classify severity

Answer 2

Mild - pH < 7.3, HCO3 <15
Mod - pH <7.2, HCO3 <10
Severe - pH <7.1 HCO <5

Question 3

Diagnosis

Answer 3

BGL >11, pH <7.3/ HCO3 <15, Ketones >0.6

Question 4

Investigations

Answer 4

FBC - HCT
VBG -pH
UEC - HCO3, K
BGL
ECG - T wave - K changes
Urine dipstick - ketones, Glu

Question 5

Complications

Answer 5

Cerebral Oedema
Hypoglycaemia
Hypo/hyperkalaemia
Hypo/hypernatraemia
Aspiration (obtunded)

Question 6

Treatment

Answer 6

Resus. - IVC, VBG
Fluid - 10ml/kg NS bolus, 0.9% N/s + KCl , Target BSL 5-12
K - target >5.5
Insulin - 50U Actrapid in 50mls NS
0.1 U/kg/hr (BSL>15)
0.05 U/kg/hr (BSL <15)
continue infusion until acidosis & ketones corrected
Q1hrly BSL, ketons
Q2hrly VBG

Question 7

Cerebral Oedema

Answer 7

Occurs suddenly usually within 6-12 hrs
Risk fx - 1st presentation, BSL rapid correction >5mmol/hr, age <5 y.o , long hx poor control
Mx: Mannitol 20% 0.5g/kg over 20mins
Sx; early - headache, irritability, lethargy
late - decrease LOC, incontinence
v.late - bradycardia, hypertension, resp impairment