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Therapeutics 2 - Fall 2017 > DKA > Flashcards

DKA Flashcards

1
Q

DKA or HHS or both?

Absolute Insulin Deficiency

A

DKA

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2
Q

DKA or HHS or both?

Lipolysis –> FFA

A

DKA

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3
Q

DKA or HHS or both?

increased inflammatory mediators and CV risk factors can cause it

A

Both!!

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4
Q

DKA or HHS or both?

Relative insulin deficiency

A

HHS

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5
Q

DKA or HHS or both?

SEVERE dehydration

A

HHS

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6
Q

DKA or HHS or both?

Increased counterregulatory homrones

A

both!

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7
Q

DKA or HHS?

usually has high glucose levels than the other

A

HHS (has SEVERE hyperglycemia)

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8
Q

DKA or HHS or both?

has increased total body ketones

A

both

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9
Q

DKA or HHS or both?

More common in type 1

A

DKA

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10
Q

DKA or HHS or both?

more common in type 2

A

HHS

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11
Q

DKA or HHS or both?

Metabolic Acidosis

A

DKA

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12
Q 
DKA or HHS or both?
Occurs quickly (~ 24 hrs)
A

DKA

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13
Q

DKA or HHS or both?

Occurs over several days

A

HHS

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14
Q

Precipitating factors for DKA and HHS

A
  • medications
  • inadequate insulin therapy
  • INFECTIONS
  • CV events
  • Pancreatitis
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15
Q

Types of medications that precipitate DKA/HHS

A

Diuretics, corticosteroids, Sympathomimetics,

Anticonvulsant, Antipsychotics

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16
Q

Symptoms seen in DKA and HHS

A
  • Polyuria
  • Polydipsia
  • Wt loss
  • N/V/D (more DKA…)
  • Dehydration
  • weakness
  • mental status change
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17
Q

DKA or HHS or both?

Kussmaul respirations

A

DKA

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18
Q

DKA or HHS or both?

Fruity breath

A

DKA

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19
Q

DKA or HHS or both?

N/V/D

A

DKA

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20
Q

DKA or HHS or both?

Poor skin turgor

A

both

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21
Q

DKA or HHS or both?

Tachycardia

A

both

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22
Q

DKA or HHS or both?

Hypotension

A

both (bc vasodilation)

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23
Q

DKA or HHS or both?

Normothermic or Hypothermic

A

both

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24
Q

DKA or HHS or both?

Seizures

A

HHS

25
Q

DKA or HHS or both?

Coma

A

HHS

26
Q

DKA or HHS or both?

Lethargy

A

HHS

27
Q

Labs that are looked at for DKA/HHS

A
  • Chem7
  • Arterial blood gas
  • Hemoglobin A1c
  • CBC w/ differential (bc infection)
  • Urinalysis
  • Plasma osmolality
  • Electrocardiogram
  • Urine, sputum, blood cultures
28
Q

DKA Lab Values:

Glucose level seen in DKA

A

> 250 mg/dL

29
Q

DKA Lab Values:

Arterial pH

A

acidotic so less than 7.35!! (severe is like 7)

30
Q

DKA Lab Values:

HCO3- levels

A

less than 24!! (severe is like 10)

31
Q

DKA Lab Values:

Anion gap

A

> 12

32
Q

Anion Gap Eqn

A

Na - Cl - HCO3

33
Q

Serum Osmolality Eqn

A

(2 x Na) + (glucose/18)

34
Q

Corrected Serum Sodium Eqn

A

Na + 0.016(glucose - 100)

35
Q

For DKA and HHS:

Is BUN decrease or increased?

A

increased!!

36
Q

What other things can cause ketoacidosis other than DKA

A
  • starvation ketoacidosis (bicarb usually wont be less than 18….)
  • Alcoholic Ketoacidosis
37
Q

What other things can cause high anion gap metabolic acidosis

A
  • lactic acidosis
  • Ingestion of medication (salicylate, menthol, ethylene, glycol, paraldehyde)
  • Chronic renal failure
38
Q

what is CrCl equation?

A

(140 - age) (IBW) / (72 x SCr)

multiplied by 0.85 if woman

39
Q

How to treat DKA/HHS

A

1 - IV fluids
2 - insulin
3 - electrolyte replacement

40
Q

Goals of Therapy with Fluid Replacement in DKA/HHS:
_______ of intravascular, interstitial, intracellular volume
Restoration of _________
Avoidance of ___________
Correcting deficit within _______

A

Expansion; renal perfusion, cerebral edema, 24 hours

41
Q

Fluid replacement for DKA/HHS:
initial therapy _______
at what type of rate?

A

0.9% NaCl @ 15 - 20 mL/kg/hr OR 1 - 1.5 L during 1st hour

42
Q

Fluid replacement for DKA/HHS:

Subsequent Therapy if LOW SODIUM

A

Continue 0.9% NaCl

Rate = 250 - 500 mL/hr

43
Q

Fluid replacement for DKA/HHS:

Subsequent Therapy if NORMAL/HIGH SODIUM

A

Switch to 0.45% NaCl

Rate = 250 - 500 mL/hr

44
Q

Fluid replacement for DKA/HHS:
Subsequent Therapy
If Glucose is <200 (DKA) or < 300 (HHS)…. do what?

A

Switch to D5W in 0.45% NaCl

45
Q

Do not start insulin therapy if _________ is present

A

hypokalemia

if K+ is less than 3.3 mEq/L

46
Q

Do not start insulin if K+ is less than ______

A

3.3 mEq/L

47
Q

How to give insulin for DKA/HHS:

Given as BOLUS

A

Bolus: 0.1 units/kg
THEN
continuous infusion @ 0.1 units/kg/hr

48
Q

How to give insulin for DKA/HHS:

Given as NO BOLUS

A

Continuous IV infusion at 0.14 units/kg/hr

49
Q

How to give insulin for DKA/HHS:
Can decrease infusion rate to ____ units/kg/hr once glucose is < _____ in DKA OR
< _____ in HHS

A

0.02 - 0.05; 200; 300

50
Q

What factors can cause decrease in serum K+

A

insulin therapy; correction of acidosis; volume repletion

51
Q

Potassium Goal during DKA/HHS: ?

A

4 - 5 mEq/L

52
Q

Can start K+ replacement when K+ is ______

A

< 5.3 mEq/L

53
Q

How to replace K+ (via fluids)

A

20 - 30 mEq KCl in each liter of fluid replacement

54
Q

Pts that come to get medical attention with DKA/HHS - generally have _____kalemia but are at risk for ______kalemia

A

HYPER; HYPO

55
Q

How to prevent cerebral edema?

A

Gradual replacement of Na/H2O (NMT 50/mL/kg in first 4 hours!!!)

56
Q

DKA is resolved when what happens?

A 
1 - BG < 200
AND ONE OF THE FOLLOWING
- serum bicarb > 15
- Venous pH > 7.3 
- Anion Gap < 12 mEq/L
57
Q

HHS is resolved what happens?

A

1 - BG < 300
2 - Normal osmolality
3 - Normal mental status

58
Q

when to transition from IV insulin to SQ insulin?

A

Pts hyperglycemic crisis has resolved

Pt is eating

Therapeutics 2 - Fall 2017 (22 decks)

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