DKA

Question 1

at what dose should insulin be given for treatment of DKA?

Answer 1

0.1 unit/kg/ hour

once glucose < 15 then IV dextrose infusion should be started

Question 2

why is fluids given as a slow infusion?

Answer 2

reduce risk of cerebral oedema

Question 3

what are the complications of DKA and its treatment?

Answer 3

AKI
acute respiratory distress syndrome
arrhythmia due to hyperkalaemia, iatrogenic hypokalaemia
iatrogenic injury due to incorrect fluid therapy
gastric status

Question 4

at what potassium level would you replace K in fluids and at what concentration?

Answer 4

if K > 5.5 - no replacement
3.5 - 5.5 - 40 mmol/L
< 3.5 - senior review

Question 5

what blood results would you expect in DKA?

Answer 5

blood glucose > 11 mmol/l
blood ketones > 3 mmol/l
urinary ketones > ++ on dipstick 
bicarbonate < 15
PH < 7.3

Question 6

what might precipitate DKA?

Answer 6

infection
MI
missed insulin

Question 7

if hyperosmolar hyperglycaemic state occurred alongside DKA, at what rate would you give insulin?

Answer 7

0.05 units/kg/hour