DKA and HHS

Question 1

What causes DKA?

Answer 1

Uncontrolled lipolysis leading to excess free fatty acids -> ketone bodies.

Exacerbated T1 diabetes, infection, missed doses, MI.

Question 2

Symptoms and signs of DKA

Answer 2

Abdominal pain, polyuria, polydipsia, dehydration, Kussmaul breathing, acetone breath

Question 3

Management of DKA

Answer 3

Fluid replacement- DKA patients are usually 5-8L down.

Insulin- infusion of 0.1 unit/kg/hour. Once blood glucose is <15 an infusion of 5% dextrose should be started.

Correct electrolyte disturbances- serum potassium is high but total body potassium is low. Once treatment is started potassium may fall quickly. May need to add K to the fluids,

Question 4

DKA complications

Answer 4

Thromboembolism, arrhythmias, cerebral oedema, ARDS, AKI.

Question 5

Hyperosmolar hyperglycaemic state

Answer 5

Complication of T2 diabetes.
Extreme hyperglycaemia leads to osmotic diuresis, severe dehydration and electrolyte disturbances.
Severe volume depletion -> raised serum osmolarity -> hyperviscosity of blood.

Question 6

HHS complications

Answer 6

MI, stroke, peripheral arterial thrombosis

Question 7

HHS symptoms

Answer 7

Fatigue, nausea and vomiting.
May not look dehydrated due to preservation of intravascular volume. Tachycardia, hypotension.
Altered consciousness, headache, papilledema, weakness.
Clot complications - MI, stroke

Question 8

HHS diagnosis

Answer 8

Hypovolaemia
Marked hyperglycaemia > 30mmol/L without significant ketosis or acidosis
Markedly raised serum osmolarity > 320

Question 9

HHS management

Answer 9

Normalise osmolality gradually
Replace fluids and electrolytes
Normalise blood glucose gradually.

Question 10

DKA diagnosis

Answer 10

Glucose > 11
pH < 7.3
Bicarbonate < 15
Ketones > 3 or ++ urine