DKA

Question 1

What is DKA?

Answer 1

Serious and fatal

Complication of existing T1DM or first presentation

Question 2

What is the pathophysiology?

Answer 2

Uncontrolled lipolysis = xs FFA = converted into ketone bodies

Question 3

What are the precipitating RF?

Answer 3

Infection
Missed insulin dose
MI

Question 4

What are the dx critera?

Answer 4

Glucose >11 mmol/l
(Acidosis) pH <7.3, HCO3 <15 mmol/l
Plasma ketones > 3 mmol/l OR urine dip ketones ++

Question 5

How do pts present?

Answer 5

Polyuria, polydipsia
Dehydration 
Abdo pain, N/V
Weight loss
KUSSMAUL RESPIRATION**
Pear-drop (acetone) breath

Question 6

How is it mx?

Answer 6

Acute
(1)***IV isotonic saline
IV insulin 0.1 unit/kg/h
IV 5% dextrose (once glucose <15 mmol/l!!!)
Correct hypoK
Long-acting insulin continued, STOP short-acting insulin

Question 7

What IV fluid is given?

Answer 7

0.9% NaCl 1L - 1st hr
0.9% NaCl 1L + KCl - next 2h
Repeat
0.9% NaCl 1L + KCl - next 4h
Repeat
0.9% NaCl 1L + KCl - next 6h

Question 8

What care should be taken when giving IV fluid to young adults (18-25)?

Answer 8

Slower infusion as greater risk of cerebral oedema

Question 9

What are the complications of DKA and its RX?

Answer 9

Gastric stasis
Thromboembolism
Arrhythmia 2 to hyperK
Cerebral oedema 
ARDS
AKI