DKA

Question 1

Diabetic ketoacidosis

Answer 1

• May be a complication of existing type 1 diabetes
• Could be first presentation
• Most common presentations are infection, missed insulin and MI

Features:

• Pain
• Polyuria, Polydipsia, Deyhdration
• Kussmaul respiration (deep ventilation)
• Acetone smelling breath

Question 2

Diagnostic Criteria

Answer 2

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 3

DKA Complications

Answer 3

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

Calcium gluconate is given to protect heart from arrhythmias

Question 4

DKA

Conclusion

Answer 4