DKA and Adrenal Insufficiency

Question 1

Review of aldosterone physiology

Answer 1

• it take Na and reabsorbs it from urine and puts it back into the blood
• result of hyperaldosterone =
• HTN
• expanded extracellular fluid volume (but no edema)
• hypokalemia
• metabolic alkalosis

Question 2

presentation of hypoaldosteronism

Answer 2

• may have hx of recent steroid therapy where adrenal are suppressed from chronic inhibition of pituitary
• may just have hx of lassitude, fatigue, dizziness upon rising

Question 3

PE in hypoaldosteronism

Answer 3

• evidence of volume contraction
• positive tilt test
• possible hyperpigmentation of skin

Question 4

lab results in hypoaldosteronism

Answer 4

• Na: 130
• K: 6.0
• Cl: 106
• HCO3: 18

Question 5

anion gap formula

Answer 5

Na - (Cl + HCO3)

cations - anions

Question 6

nl anion gap

Answer 6

• per textbook: 12

- clinically: 12-18

Question 7

classic presentation of DKA

Answer 7

• pt w/ DM type I and have become ill, usu infection, or cannot eat and haven’t taken insulin
• Type II can also present in rare cases

Question 8

review of insulin physiology

Answer 8

-insulin forces glucose into muscle cells and inhibits breakdown of adipose tissue

Question 9

DKA phys review

Answer 9

• when there is a lack of insulin:
• adipose breaks down and releases FFA into the blood stream
• the liver takes up the FFA and turns them into ketone bodies
• glucose can’t be taken up into muscle cells so get hyperglycemic
• have tremendous urine volume d/t hyperosmolality from the sugar

Question 10

ketones released in DKA

Answer 10

• when ketoacids hit the bloodstream and dissociate, they leave H ion and base:
• either aceto-acetate or beta-hydroxybuterate
• this widens the anion gap