DKA

Question 1

DKA Sx

Answer 1

Features
abdominal pain
polyuria, polydipsia, dehydration
Kussmaul respiration (deep hyperventilation)
Acetone-smelling breath (‘pear drops’ smell)

Question 2

Diagnostic criteria DKA

Answer 2

glucose > 11 mmol/l or known diabetes mellitus
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick

Question 3

Mx DKA

Answer 3

Management
fluid replacement: most patients with DKA are deplete around 5-8 litres. Isotonic saline is used initially.

insulin: an intravenous infusion should be started at 0.1 unit/kg/hour.

Once blood glucose is < 15 mmol/l an infusion of 5% dextrose should be started
correction of hypokalaemia

Question 4

Complications DKA

Answer 4

Complications of DKA and its treatment
gastric stasis
thromboembolism
arrhythmias secondary to hyperkalaemia/iatrogenic hypokalaemia
iatrogenic due to incorrect fluid therapy: cerebral oedema, hypokalaemia, hypoglycaemia
acute respiratory distress syndrome
acute kidney injury