DKA

Question 1

What is the typical progression of DKA?

Answer 1

Gradual drowsiness, vomiting and dehydration in a T1DM

Question 2

What symptoms can DKA present with?

Answer 2

Polyuria
Polyphagia
Polydipsia
Weight loss
N&V
Abdo pain
Dry mucous membranes
Poor skin turgor
Sunken eyes
Tachycardia
Hypotension
Kussmaul breathing (rapid and deep)
Acetone breath
Altered mental state

Question 3

What are the major risk factors for DKA in a T1DM?

Answer 3

Inadequate or inappropriate insulin therapy
Infection
MI

Question 4

What venous bloods are required in DKA?

Answer 4

Glucose
Ketones
U&Es
Mg
Ca
Ph
Lactate
LFTs
Amylase
Lipase
Osmolality
Anion gap
FBC

Question 5

What tests (other than venous bloods) should be done in DKA?

Answer 5

ABG
Pinprick glucose
Capillary ketones
Urinalysis

Question 6

What are the 3 things required to make a diagnosis of DKA?

Answer 6

Acidosis
Hyperglycaemia
Ketosis

Question 7

What are the criteria for diagnosing severe DKA?

Answer 7

pH <7.1 or HCO3 <5 or H+ >80

Question 8

When in DKA should a senior be called immediately?

Answer 8

Cerebral oedema
Hypokalaemia on admission
Severe DKA
Reduced conscious level

Question 9

What immediate actions should be done for someone in suspected DKA?

Answer 9

Confirm Diagnosis
Check U&Es and lab BG
Check urine or blood ketones
Record time of arrival
Confirm age of patient (different protocol for those <16)

Question 10

What criteria is needed from a venous blood gas to confirm a diagnosis of DKA?

Answer 10

H+ >45 or HCO£ <18 or pH <7.3

Question 11

What management should be commenced within the first 30 mins of arrival?

Answer 11

Commence IV NaCl 1L over 1 hour

Commence soluble insulin 6units/hour (actrapid)

Question 12

What management should be commenced within the first hour of arrival?

Answer 12

Record NEWS

Question 13

What management should be done within hours 1-4?

Answer 13

NEWS, ECG and GCS
Hour 2 = 1L Nacl + KCl
Hours 3-4 = 500ml/hour NaCl + KCl
Review K+ result and prescribe KCl based on result
Check fingerprick glucose hourly
Lab glucose, U&Es and HCO3 at hours 2 and 4

Question 14

How many mmol K+ should be given if K+ level recorded as >5 or if patient is anuric?

Answer 14

None

Question 15

How many mmol K+ should be given if K+ level recorded as 3.5-5?

Answer 15

10mmol

Question 16

How many mmol K+ should be given if K+ level recorded as <3.5?

Answer 16

20mmol

Question 17

What should be done if BG falls to <14 within 4 hours?

Answer 17

Start Glucose 10% 500mls with 20mmol KCl at 100ml/hour
Continue NaCl at 400mls/hour +KCl until end of hour 4
Reduce insulin to 3units/hour
Maintain BG >9 and <14
Move on to secondary protocol

Question 18

What 3 criteria must a patient meet before the can be discharged following a DKA episode?

Answer 18

HCO3 normal
Eating normally
On usual daily SC insulin regimen

Question 19

When converting from IV to SC insulin regimens, when should the IV insulin (and fluids) be stopped in relation to starting SC insulin?

Answer 19

30 mins after injection of usual SC pre-meal insulin