DKA

Question 1

what causes type 1 DM

Answer 1

autoimmune destruction of the insulin producing B cells of the endocrine pancreas

t cell mediated

associated with islet cell antibodies

Question 2

how does insulin act in the muscle

Answer 2

increased uptake of amino acids, anabolism

decreased catabolism and gluconeogenesis

Question 3

how does insulin act in the fat

Answer 3

increases uptake of FFAs, lipogenesis

decreases lipolysis and ketone bodies

Question 4

how does insulin act in the liver

Answer 4

increases uptake of glucose and glycogen synthesis

decreases glycogenolysis

Question 5

how does insulin affect glucose sensing

Answer 5

insulin is required for glucose to enter into the glucostat cells in the hypothalamus

without insulin the body thinks it is hypoglycemic

in defence, releases stress hormones like epinephrine, glucagon growth hormone and cortisol

increased ketones and gluconeogenesis

Question 6

what are the elements of fixing DKA?

Answer 6

water

sodium

potassium

insuin

fix acidosis

glucose?

Question 7

how can you estimate dehydration

Answer 7

HR, BP

mucous membranes–tears, not mouth

urine output?

skin turgor

capillary refill

JVP? orthostatic BP?

weight?

Question 8

what % of reduction in fluid volume corresponds to mild, moderate and severe dehydration in an infant?

Answer 8

mild–5%

moderate–10%

severe–15%

Question 9

what % of reduction in fluid volume corresponds to mild, moderate and severe dehydration in a child?

Answer 9

mild–3%

moderate–6%

severe–9-10%

Question 10

how do you calculate repair fluid volume to replace losses from dehydration?

Answer 10

10% equals 100cc/kg

equation:
% dehydration x weight in kg equals cc repair fluid required

Question 11

how do you calculate maintenance fluids

Answer 11

4-2-1 rule

4cc/kg/h for first 10 kg–>40cc/h

2 cc/kg/h for second 10 kg–> 20 cc/h

1 cc/kg/h for the rest–> ?cc/h

adds up to total amount of fluid maintenance per hour

Question 12

how do you calculate fluids per day of maintenance fluids?

Answer 12

100-50-20 rule

100 cc/kg/day for first 10 kg–> 1000 cc/day

50 cc/kg/day for second 10 kg–> 500 cc/day

20 cc/kg/day for rest–> ? cc/day

can double it for 48 hours of maintenance

Question 13

how do you calculate fluid push amount?

Answer 13

10cc/kg x weight in kg–> ?cc NS resuscitation

Question 14

what amount of sodium is generally lost in DKA? how do you manage?

Answer 14

5-13 mmol/kg

use NS to begin

may eventually switch to 1/2NS

Question 15

what amount of potassium is generally lost in DKA? how do you manage?

Answer 15

loss is 3-6 mmol/kg

NS plus 40mEq/L KCl at 100 cc/h

Question 16

how much insulin do you use to correct DKA? what is the goal of using insulin?

Answer 16

0.05-0.1 U/kg/h–> 1/2-2/4 U/kg/day

goal is to completely suppress ketone body formation and gluconeogenesis

STAT 1-2 h after fluids (fluids first)

add glucose eventually in order to keep glucose within 8-12 range

Question 17

how do you treat lactic acidosis

Answer 17

fluids

Question 18

how do you treat ketoacidosis

Answer 18

insulin

Question 19

should you give bicarb when treating DKA

Answer 19

NO

Question 20

what monitoring needs to be done while managing DKA

Answer 20

Na
K
Cl
HCO3
anion gap q2-4h
capillary pH
pCO2
base defecit
urine ketones or blood betahydroxybutarate 
calcium
phosphate
urea
creatinine
glucose by fingerpoke q30-60 min
neurovitals

Question 21

what is cushings triad and what does it indicate?

Answer 21

cushings triad–increased BP, lowered HR, irregular HR

suggests cerebral edema

other signs include headache, posturing

Question 22

how do you manage cerebral edema/suspected cerebral edema in the management of DKA

Answer 22

decrease fluids
elevate head of bed
mannitol/3% saline
intubate

Question 23

name 3 types of rapid acting insulin

Answer 23

humalog
novorapid
apidra

Question 24

name 2 types of short acting insulin

Answer 24

regular

toronto

Question 25

name an intermediate acting insulin

Answer 25

NPH

Question 26

name 3 types of long acting insulin

Answer 26

basaglar
levemir
lantus

Question 27

why is activity important in managing T1DM

Answer 27

decreases blood glucose secondary to insulin independent glucose transport via GLUT4

can also get increased BG secondary to adrenaline

benefits are lower insulin resistance and thus dose, weight control, CV benefits, fun