DKA case Flashcards
What are the classic signs of DKA?
Nausea, vomiting, pronounced thirst, excessive urine production, (severe) abdominal pain
Hyperglycemia - coffee ground vomit, pancreatitis, appendicitis, GI perforation, Kussmaul respiration
Dehydration
Cerebral edema in children
How does arterial blood gases related to acid base balance?
ABG provides valuable information about blood pH, pCO2, pO2, serum bicarbonate, base excess
What is the main pH Buffering system?
Carbonic acid-bicarbonate system
Which system controls CO2 and how?
Respiratory system
Breathe rapidly to blow off/release CO2, removing it from blood to increase pH
Slow or shallow breathing yields CO2 retention to blood becomes more acidic
Which system controls serum bicarbonate?
Kidneys
Modulate amount of bicarbonate in blood & ECF through increased production/reabsorption of these ions
Can further regulate pH by varying amount of H+ ions excreted in urine
What are the goals in treatment of DKA?
Step 1 = fluid restoration
Step 2 = put patient on insulin & maintain insulin level
Step 3 = restore & maintain blood electrolyte levels
What are three major complications of DKA?
Cerebral edema
Severe hypokalemia
Adult respiratory distress syndrome
(Liver failure, kidney failure, mucor rhizopus fungi)
What occurs if there is a lack of insulin in glycolysis?
Decrease; RBC, muscle
Inhibited b/c don’t have insulin so glucose in blood is maintained
What occurs if there is a lack of insulin in gluconeogenesis?
Increase; liver - have high glucagon (muscle, adipose tissues) b/c body is starving
Requires insulin; tissues are starving - induce pathways to supplement lack of glucose
What occurs if there is a lack of insulin in FA oxidation?
Increase; liver, muscle
What occurs if there a lack of insulin in glycogen breakdown?
Increase (due to glucagon)
Glycogen phosphorylase is activated
Activate fructose-1,6-bisphosphotase
Activating TAG lipase
How to elevated levels of ketone bodies in the blood lead to adverse symptoms of DKA?
FFA are converted into ketone bodies, which make blood acidic
When accumulated ketones exceed body’s capacity to extract them, they overflow into urine - leads to metabolic acidosis
What are the symptoms of too many ketone bodies in the blood?
Ketonuria, N&V, electrolyte loss, fruity breath, dehydration, acidosis, and low CO2 leading to cerebral edema
How would a pt with a transient ischemic attack (TIA) be managed?
Anticoagulant medications – heparin, warfarn
Anti-platelet medications – aspirin, clopidogrel, ticlopidine
Lifestyle changes for prevention
