DKA Flashcards
what causes type 1 DM
autoimmune destruction of the insulin producing B cells of the endocrine pancreas
t cell mediated
associated with islet cell antibodies
how does insulin act in the muscle
increased uptake of amino acids, anabolism
decreased catabolism and gluconeogenesis
how does insulin act in the fat
increases uptake of FFAs, lipogenesis
decreases lipolysis and ketone bodies
how does insulin act in the liver
increases uptake of glucose and glycogen synthesis
decreases glycogenolysis
how does insulin affect glucose sensing
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
what are the elements of fixing DKA?
water
sodium
potassium
insuin
fix acidosis
glucose?
how can you estimate dehydration
HR, BP
mucous membranes–tears, not mouth
urine output?
skin turgor
capillary refill
JVP? orthostatic BP?
weight?
what % of reduction in fluid volume corresponds to mild, moderate and severe dehydration in an infant?
mild–5%
moderate–10%
severe–15%
what % of reduction in fluid volume corresponds to mild, moderate and severe dehydration in a child?
mild–3%
moderate–6%
severe–9-10%
how do you calculate repair fluid volume to replace losses from dehydration?
10% equals 100cc/kg
equation:
% dehydration x weight in kg equals cc repair fluid required
how do you calculate maintenance fluids
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
how do you calculate fluids per day of maintenance fluids?
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
how do you calculate fluid push amount?
10cc/kg x weight in kg–> ?cc NS resuscitation
what amount of sodium is generally lost in DKA? how do you manage?
5-13 mmol/kg
use NS to begin
may eventually switch to 1/2NS
what amount of potassium is generally lost in DKA? how do you manage?
loss is 3-6 mmol/kg
NS plus 40mEq/L KCl at 100 cc/h
how much insulin do you use to correct DKA? what is the goal of using insulin?
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
how do you treat lactic acidosis
fluids
how do you treat ketoacidosis
insulin
should you give bicarb when treating DKA
NO
what monitoring needs to be done while managing DKA
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
what is cushings triad and what does it indicate?
cushings triad–increased BP, lowered HR, irregular HR
suggests cerebral edema
other signs include headache, posturing
how do you manage cerebral edema/suspected cerebral edema in the management of DKA
decrease fluids
elevate head of bed
mannitol/3% saline
intubate
name 3 types of rapid acting insulin
humalog
novorapid
apidra
name 2 types of short acting insulin
regular
toronto
name an intermediate acting insulin
NPH
name 3 types of long acting insulin
basaglar
levemir
lantus
why is activity important in managing T1DM
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
