DKA Flashcards
DKA or HHS or both?
Absolute Insulin Deficiency
DKA
DKA or HHS or both?
Lipolysis –> FFA
DKA
DKA or HHS or both?
increased inflammatory mediators and CV risk factors can cause it
Both!!
DKA or HHS or both?
Relative insulin deficiency
HHS
DKA or HHS or both?
SEVERE dehydration
HHS
DKA or HHS or both?
Increased counterregulatory homrones
both!
DKA or HHS?
usually has high glucose levels than the other
HHS (has SEVERE hyperglycemia)
DKA or HHS or both?
has increased total body ketones
both
DKA or HHS or both?
More common in type 1
DKA
DKA or HHS or both?
more common in type 2
HHS
DKA or HHS or both?
Metabolic Acidosis
DKA
DKA or HHS or both? Occurs quickly (~ 24 hrs)
DKA
DKA or HHS or both?
Occurs over several days
HHS
Precipitating factors for DKA and HHS
- medications
- inadequate insulin therapy
- INFECTIONS
- CV events
- Pancreatitis
Types of medications that precipitate DKA/HHS
Diuretics, corticosteroids, Sympathomimetics,
Anticonvulsant, Antipsychotics
Symptoms seen in DKA and HHS
- Polyuria
- Polydipsia
- Wt loss
- N/V/D (more DKA…)
- Dehydration
- weakness
- mental status change
DKA or HHS or both?
Kussmaul respirations
DKA
DKA or HHS or both?
Fruity breath
DKA
DKA or HHS or both?
N/V/D
DKA
DKA or HHS or both?
Poor skin turgor
both
DKA or HHS or both?
Tachycardia
both
DKA or HHS or both?
Hypotension
both (bc vasodilation)
DKA or HHS or both?
Normothermic or Hypothermic
both
DKA or HHS or both?
Seizures
HHS
DKA or HHS or both?
Coma
HHS
DKA or HHS or both?
Lethargy
HHS
Labs that are looked at for DKA/HHS
- Chem7
- Arterial blood gas
- Hemoglobin A1c
- CBC w/ differential (bc infection)
- Urinalysis
- Plasma osmolality
- Electrocardiogram
- Urine, sputum, blood cultures
DKA Lab Values:
Glucose level seen in DKA
> 250 mg/dL
DKA Lab Values:
Arterial pH
acidotic so less than 7.35!! (severe is like 7)
DKA Lab Values:
HCO3- levels
less than 24!! (severe is like 10)
DKA Lab Values:
Anion gap
> 12
Anion Gap Eqn
Na - Cl - HCO3
Serum Osmolality Eqn
(2 x Na) + (glucose/18)
Corrected Serum Sodium Eqn
Na + 0.016(glucose - 100)
For DKA and HHS:
Is BUN decrease or increased?
increased!!
What other things can cause ketoacidosis other than DKA
- starvation ketoacidosis (bicarb usually wont be less than 18….)
- Alcoholic Ketoacidosis
What other things can cause high anion gap metabolic acidosis
- lactic acidosis
- Ingestion of medication (salicylate, menthol, ethylene, glycol, paraldehyde)
- Chronic renal failure
what is CrCl equation?
(140 - age) (IBW) / (72 x SCr)
multiplied by 0.85 if woman
How to treat DKA/HHS
1 - IV fluids
2 - insulin
3 - electrolyte replacement
Goals of Therapy with Fluid Replacement in DKA/HHS:
_______ of intravascular, interstitial, intracellular volume
Restoration of _________
Avoidance of ___________
Correcting deficit within _______
Expansion; renal perfusion, cerebral edema, 24 hours
Fluid replacement for DKA/HHS:
initial therapy _______
at what type of rate?
0.9% NaCl @ 15 - 20 mL/kg/hr OR 1 - 1.5 L during 1st hour
Fluid replacement for DKA/HHS:
Subsequent Therapy if LOW SODIUM
Continue 0.9% NaCl
Rate = 250 - 500 mL/hr
Fluid replacement for DKA/HHS:
Subsequent Therapy if NORMAL/HIGH SODIUM
Switch to 0.45% NaCl
Rate = 250 - 500 mL/hr
Fluid replacement for DKA/HHS:
Subsequent Therapy
If Glucose is <200 (DKA) or < 300 (HHS)…. do what?
Switch to D5W in 0.45% NaCl
Do not start insulin therapy if _________ is present
hypokalemia
if K+ is less than 3.3 mEq/L
Do not start insulin if K+ is less than ______
3.3 mEq/L
How to give insulin for DKA/HHS:
Given as BOLUS
Bolus: 0.1 units/kg
THEN
continuous infusion @ 0.1 units/kg/hr
How to give insulin for DKA/HHS:
Given as NO BOLUS
Continuous IV infusion at 0.14 units/kg/hr
How to give insulin for DKA/HHS:
Can decrease infusion rate to ____ units/kg/hr once glucose is < _____ in DKA OR
< _____ in HHS
0.02 - 0.05; 200; 300
What factors can cause decrease in serum K+
insulin therapy; correction of acidosis; volume repletion
Potassium Goal during DKA/HHS: ?
4 - 5 mEq/L
Can start K+ replacement when K+ is ______
< 5.3 mEq/L
How to replace K+ (via fluids)
20 - 30 mEq KCl in each liter of fluid replacement
Pts that come to get medical attention with DKA/HHS - generally have _____kalemia but are at risk for ______kalemia
HYPER; HYPO
How to prevent cerebral edema?
Gradual replacement of Na/H2O (NMT 50/mL/kg in first 4 hours!!!)
DKA is resolved when what happens?
1 - BG < 200 AND ONE OF THE FOLLOWING - serum bicarb > 15 - Venous pH > 7.3 - Anion Gap < 12 mEq/L
HHS is resolved what happens?
1 - BG < 300
2 - Normal osmolality
3 - Normal mental status
when to transition from IV insulin to SQ insulin?
Pts hyperglycemic crisis has resolved
Pt is eating
