DKA 2022

Question 1

Risk Factors for DKA

Answer 1

Younger age, lower SES, delayed diagnosis in new patients, previous DKA, poor glycemia control, unrecognized pump malfunction, infection, certain meds, ethnicity, limited access to care, co-existing mental health or social and family issues, peripubertal stage, and adolesence

Question 2

Medications that increase risk for DKA (3)

Answer 2

Long acting insulin analogues, atypical antipsychotics, glucocorticoids

Question 3

DKA vs HHS

Answer 3

HHS has more severe volume depletion and extreme electrolyte imbalances, without ketosis or acidosis

Question 4

Presenting symptoms of DKA

Answer 4

Polyuria, polydipsia, polyphagia, weakness, nausea, vomiting, abdominal pain, decreased LOC, Kussmaul breathing, and acetone

Question 5

Labs to order for DKA

Answer 5

Glucose, lytes (including Ca, Mg, phosphate), urea, creatinine, anion gap, blood gas, osmolality, serum or urine ketones, and beta-hydroxybutyrate

Question 6

Lab values needed to diagnose DKA

Answer 6

Glucose > 11
B-hydroxybutyrate >/= 3 and/or moderate or large ketones
pH <7.3, measured bicarb <18, with anion gap >12

Question 7

Morbidity and mortality rates in cerebral injury from DKA

Answer 7

21-25%

Question 8

Risk factors for cerebral injury from DKA

Answer 8

New onset diabetes
Longer duration of symptoms
Age < 5 years
Severe acidosis
Severe dehydration
Hypocapnia
Insulin therapy in first hr or insulin bolus
Rapid administration of hypotonic fluids
Use of sodium bicarb
Failure of measured sodium to rise during treatment

Question 9

How much fluid to bolus in DKA?

Answer 9

10 to 20 mL/kg of NS over 20 to 30 mins
If hypotensive or has compensated shock, can give over 10 to 15 mins

Question 10

How fast can you decreased plasma glucose?

Answer 10

No more than 5 mmol/L per hour

Question 11

When do you add dextrose containing fluids?

Answer 11

When glucose is between 15 and 17

Question 12

Target blood glucose levels while treating DKA

Answer 12

7 to 11

Question 13

Criteria to start insulin

Answer 13

After first hour of fluids
K levels > 3.0 (replace before starting insulin if low)

Question 14

How to calculate corrected serum sodum

Answer 14

Measured sodium + ( (glucose - 5) x 0.3)

Question 15

Why should you monitor corrected sodium?

Answer 15

A change of more than 2 to 3 may indicate excessive or inadequate fluid resuscitation

Question 16

How much K should be added when serum K is less than 5?

Answer 16

40 mmol/L
AFTER recent urine output is documented!

Question 17

When to replace phosphate

Answer 17

Serum phosphate < 0.5
Or concerns of cardiac dysfunction, respiratory failure, gastrointestinal dysmotility, or metabolic encephalopathy

Question 18

How frequently should labs be monitored?

Answer 18

POC glucose q1 hour
Gas q2 hours
Lytes q4 hours