DKA Flashcards
What is the blood glucose level that indicates hyperglycaemia in DKA?
Blood glucose > 11mmol/L
What blood ketone level indicates ketosis in DKA?
Blood ketones > 3mmol/L or urine ketones 2+
What bicarbonate level and pH indicate acidosis in DKA?
Bicarbonate < 15mmol/L and/or pH < 7.3
What is the primary cause of Diabetic Ketoacidosis (DKA)?
Inadequate insulin leading to hyperglycaemia
When does DKA typically occur?
Initial presentation of T1 DM, unwell T2 DM patient, patient not adhering to insulin regime
What are the key symptoms of DKA?
- Ketoacidosis
- Dehydration
- Potassium imbalance
- Hyperglycaemia
- Metabolic acidosis (with low bicarb)
- Kussmaul respirations
What are some other symptoms of DKA?
- Polyuria
- Polydipsia
- Nausea/Vomiting
- Acetone smell to breathe
- Dehydration
- Weight loss
- Low BP
- Altered consciousness
How does ketosis occur in DKA?
No/low insulin leads to liver producing ketones, resulting in high blood glucose and ketones
What causes dehydration in DKA?
High blood glucose overwhelms kidneys, causing glucose to leak into urine and osmotic diuresis
Why does potassium imbalance occur in DKA?
Before treatmetn: Glucose causes osmotic diuresis causes mass loss of water and electrolytes in urine
On treatment: Insulin drives K+ into cells; without insulin, K+ remains in serum but total body K+ is low
What can happen when insulin treatment starts in a DKA patient?
Patient can develop severe hypokalaemia leading to fatal arrhythmia
What are the diagnostic criteria for DKA?
All 3: hyperglycaemia (11mmol/L +), ketosis (blood ketone 3mmol/L +), acidosis (pH below 7.3)
What should be reversed in DKA treatment before giving insulin?
Dehydration, acidosis, and electrolyte imbalance
What should a patient be doing before stopping infusions in DKA treatment?
Eating/drinking, no ketosis/acidosis, and receiving regular SC insulin
What are some complications during DKA treatment?
- Hypoglycaemia
- Hypokalaemia
- Cerebral oedema (children)
- Pulmonary oedema (fluid overload/respiratory distress syndrome)
Fill in the blank: In DKA, the presence of _______ indicates a state of acidosis.
pH < 7.3
True or False: Kussmaul respirations are a symptom of DKA.
True
What constitutes severe DKA requiring ITU involvement?
What is the fluid replacement requirement for most patients with DKA?
5-8 litres
Patients are typically depleted of fluids in this range.
What type of saline is used initially in the management of DKA?
Isotonic saline
This is used even if the patient is severely acidotic.
What is the initial rate for intravenous insulin infusion in DKA treatment?
0.1 unit/kg/hour
This is the standard starting rate.
When should a 10% dextrose infusion be started in DKA management?
When blood glucose is < 14 mmol/l
It should be infused at 125 mls/hr in addition to the saline regime.
What is often the serum potassium level upon admission for DKA patients?
High
Despite total body potassium being low.
What may happen to potassium levels during insulin treatment in DKA?
They may fall quickly resulting in hypokalaemia
Potassium may need to be added to replacement fluids.
What monitoring is required if potassium infusion exceeds 20 mmol/hour?
Cardiac monitoring
This is essential due to potential cardiac complications.
What should be continued and stopped regarding insulin in DKA management?
Continue long-acting insulin; stop short-acting insulin
This is part of the management protocol.
What is the JBDS fluid replacement regime for a patient with a systolic BP on admission of 90mmHg?
1L 0.9% sodium chloride over various time frames
Regime includes additional potassium chloride in subsequent infusions.
What is the potassium replacement guideline for levels between 3.5-5.5 mmol/L?
40 mmol/L of infusion solution
This is the recommended replacement amount.
What defines DKA resolution?
pH >7.3, blood ketones < 0.6 mmol/L, bicarbonate > 15.0mmol/L
These criteria must be met for resolution.
What should occur if DKA criteria are met and the patient is eating and drinking?
Switch to subcutaneous insulin
This is part of the transition to outpatient care.
What complications may arise from DKA or its treatment?
- Gastric stasis
- Thromboembolism
- Arrhythmias
- Cerebral oedema
- Acute respiratory distress syndrome
- Acute kidney injury
These complications can arise from either the condition or its management.
What is a specific risk for children and young adults during DKA treatment?
Cerebral oedema
They are particularly vulnerable and require close monitoring.
How soon can cerebral oedema present after fluid resuscitation in DKA treatment?
4-12 hours
It can occur at any time, requiring vigilance in monitoring.
What should be done if there is suspicion of cerebral oedema in a DKA patient?
Seek a CT head and senior review
Timely intervention is critical for management.
