DKA Flashcards
Insulin is a 51 amino acid protein released by the ____ of the _____.
beta cells; pancreas
Insulin release is regulated by _____ within the beta cells.
a glucose sensing system
Human insulin has a half-life of about _____.
5 minutes
Kussmaul respirations
deep and rapid respirations
The acidosis seen in DKA is a result of _____.
beta oxidation of fatty acids
As the patient fights dehydration, the body compensates by holding onto ______.
sodium
K+ management in DKA pts is so important because ______.
severe hyperkalemia and severe hypokalemia can lead to death
The dehydration seen in DKA is largely the result of the _____ secondary to ______.
osmotic diuresis; hyperglycemia
Increased sodium conservation in the distal convoluted tubule and cortical collecting duct of the nephron is mediated by _____.
aldosterone
_____ is retained at the expense of _____ loss in the urine.
Sodium; potassium
bradycardia
slow heart rate
diabetes
abnormally high blood sugar
What are the signs and symptoms of cerebral edema?
mental status changes; headache; Cushing’s triad; fixed, dilated pupils
mannitol
a sugar alcohol that isn’t metabolized but will raise the osmolality of the blood to pull H2O off the brain
DKA is defined as _____, _____, and _____.
hyperglycemia, metabolic acidosis, ketonemia/ketonuria
The increased intracellular calcium ion concentration leads to _____ of preformed insulin-containing secretory granules.
exocytosis
Increased ______ conservation in the distal convoluted tubule and cortical collecting duct of the nephron is mediated by aldosterone.
sodium
hyperkalemia
abnormally high K+ in the blood
______ enters the cell through the GLUT2 transporter.
Glucose
What causes a drop in the blood pH?
ketones and lactate in the blood that exceeds the amount of HCO3- buffer
dextrose
a glucose derived from starches
In diabetes the _____ rises above levels which can be reabsorbed through facilitated diffusion and ____ is lost in the urine.
blood glucose concentration; glucose
When the ____ intracellular ratio is _____ in the cell, the ATP-sensitive K+ channel is closed.
ATP/ADP; increased
____ of patients with cerebral edema suffer long term neurologic outcomes.
20%
When the ATP/ADP intracellular ratio is increased in the cell, the _____ is closed.
ATP-sensitive K+ channel
In type ______, an autoimmune process leads to destruction of beta cells and results in insulin ______.
1 diabetes mellitus; deficiency
Glucose enters the cell through the ______.
GLUT2 transporter
The increased intracellular calcium ion concentration leads to exocytosis of _____.
preformed insulin-containing secretory granules.
With an excess of _____ in the filtrate, the body is unable to reabsorb as much ____ as it would under normal conditions, leading to polyuria.
glucose; water
Most of the body’s ______ is intracellular.
potassium
acidosis
ketone and lactate in the blood
What are insulin’s actions on the adipose tissue?
Increased glucose uptake, triglyceride uptake, lipid synthesis
Cerebral edema, occurring in about _____ of all cases of pediatric DKA, is the leading cause of morbidity and mortality, with a death rate ____.
0.15-0.3%; ~24%
Overly rapid rehydration and hypotonic IV fluids can precipitate _____.
cerebral edema
What is Cushing’s Triad?
hypertension, bradycardia, agonal respirations
High intracellular potassium _____ the membrane, activating a voltage-gated calcium channel and leading to _____.
depolarizes; calcium influx
Treatment for cerebral edema includes ______.
elevating the head of the bed, hyperventilating the patient, and giving IV mannitol or hypertonic saline
What are insulin’s actions on the muscle?
Increased glucose uptake, glycogen synthesis, and protein synthesis
The intravenous insulin serves two purposes: _____ and _____.
decreasing the blood glucose concentration; halting ketoacid production
____ is a ____ amino acid protein released by the beta cells of the pancreas.
Insulin; 51
High ______ depolarizes the membrane, activating a voltage-gated _____ channel and leading to calcium influx.
intracellular potassium; calcium
Increased sodium conservation in the _____ and ______ of the nephron is mediated by aldosterone.
distal convoluted tubule; cortical collecting duct
What are insulin’s actions on the liver?
Increased glucose uptake, glycogen synthesis, and lipogenesis Decreased gluconeogenesis, ketogenesis
Two cardinal sins in DKA management are ________ and ______.
prematurely stopping the insulin infusion; failing to use enough dextrose
_____ release is regulated by a glucose sensing system within the _____.
Insulin; beta cells
Most of the body’s potassium is ______.
intracellular
Insulin stimulates uptake of _____ and _____ while promoting synthesis of ____, _____, and _____.
glucose; triglycerides; fats, proteins, glycogen
The deep and rapid respirations seen in DKA are ____.
Kussmaul respirations
To compensate for the excess acid, the body increases _____ and ____ to hasten the elimination of carbon dioxide.
respiratory volume; rate
The increased ______ leads to exocytosis of preformed insulin-containing secretory granules.
intracellular calcium ion concentration
Because of the high blood glucose concentration, _______, even in the setting of dehydration.
large volumes of water are lost in the urine
In type 1 diabetes mellitus, an _____ process leads to ______ and results in insulin deficiency.
autoimmune; destruction of beta cells
