DKA and HHS

Question 1

What makes up the DKA Triad?

Answer 1

• Uncontrolled hyperglycemia
• Metabolic acidosis
• Ketosis

Question 2

Describe the pathogenesis of DKA.

Answer 2

1. Insulin deficiency
2. Lipolysis
3. Free fatty acids
4. Ketones
5. Acidosis

Question 3

What makes up the HHS Triad?

Answer 3

• Uncontrolled hyperglycemia
• Neurologic abnormalities
• No ketosis

Question 4

Describe the pathogenesis of HHS.

Answer 4

1. Relative insulin deficiency
2. Cells prevent lipolysis and ketogenesis
3. Severe dehydration
4. Hyperosmolarity

Question 5

Explain how dehydration occurs in HHS.

Answer 5

1. Hyperglycemia
2. Glucosuria
3. Osmotic diuresis (volume depletion, dehydration, electrolyte disturbances)

Question 6

What patient population does DKA typically affect?

Answer 6

Younger, T1DM patients

Question 7

Do DKA patients experience hyperosmolality?

Answer 7

No

Question 8

Describe the onset of DKA.

Answer 8

Develops rapidly and lasts 24 hours

Question 9

Does DKA have a high mortality rate?

Answer 9

Not really; 1-5%

Question 10

What patient population does HHS typically affect?

Answer 10

Patients older than 65 with T2DM.

Question 11

Do HHS patients experience any acidosis or ketosis?

Answer 11

No

Question 12

Do HHS patients experience hyperosmolality?

Answer 12

Yes

Question 13

Describe the onset of HHS.

Answer 13

Develops over several days

Question 14

Does HHS have a high mortality rate?

Answer 14

Decent; 5-20%

Question 15

List the precipitating factors of HHS and DKA.

Answer 15

1. Infection (pneumonia, UTI, sepsis)
2. Discontinued or inadequate insulin therapy
3. Pancreatitis
4. CV disease (usually MI)
5. Drugs (corticosteroids, thiazides, sympathomimetics, antipsychotics, pentamidine, SGLT2 inhibitors)
6. Excessive alcohol intake
7. Eating disorders

Question 16

What are the early signs of DKA?

Answer 16

• Thirst
• Frequent urination
• High BG
• Ketones in urine

Question 17

What are the later signs of DKA?

Answer 17

• Feeling weak/sleepy
• Dry/flushed skin
• Nausea/vomiting/abdominal pain
• Difficulty breathing, fruity-smelling breath
• Kussmaul respirations

Question 18

What are the 4 ways that HHS presents?

Answer 18

• Polyurea
• Polydipsia
• Weight loss
• Neurologic symptoms (lethargy, obtundation, seizures, coma)

Question 19

What are the 3 tell-tale signs of DKA?

Answer 19

• Fruity breath
• GI symptoms
• Kussmal respirations

Question 20

What are the 4 tell-tale signs of HHS?

Answer 20

• SEVERE dehydration
• Lethargy
• Seizures
• Coma

Question 21

DKA blood glucose

Answer 21

250 mg/dl or more

Question 22

DKA arterial pH

Answer 22

7.3 or less

Question 23

DKA bicarbonate concentration

Answer 23

18 mEq/L or less

Question 24

DKA anion gap

Answer 24

10 or more

Question 25

Arterial pHs for mild, moderate, and severe DKA

Answer 25

• Mild: 7.25-7.3
• Moderate: 7-7.24
• Severe: <7

Question 26

Serum bicarbonate for mild, moderate, and severe DKA

Answer 26

• Mild: 15-18
• Moderate: 10-14
• Severe: <10

Question 27

Anion gap for mild, moderate, and severe DKA

Answer 27

• Mild: >10
• Moderate and severe: >12

Question 28

SCr in DKA

Answer 28

Often elevated

Question 29

Serum Na in DKA

Answer 29

Often low or normal

Question 30

Serum K in DKA

Answer 30

Often elevated or low

Question 31

Serum PO₄^3- in DKA

Answer 31

Often elevated or normal

Question 32

WBC count in DKA

Answer 32

Mildly elevated

Question 33

Amylase/lipase in DKA

Answer 33

Often elevated