DKA - Christian

Question 1

What can precipitate DKA?

Answer 1

Infection, noncompliance, other acute event (e.g. MI)

Question 2

What is the clinical presentation of DKA?

Answer 2

polyuria, polydipsia, polyphagia, weakness, Kussmauls’respirations, nausea and vomiting

Question 3

What are the symptoms of DKA?

Answer 3

Polyuria leading to Oliguria

Dehydration, Thirst

Hypotension, Tachycardia,

Peripheral circulatory failure

Ketosis (sweet smelling breath)

Hyperventilation

Vomiting

Abdominal pain (acute abdomen)

Drowsiness, Lethargy, Coma

Question 4

How do you diagnose DKA?

Answer 4

Glucose > 250

Arterial pH 12

Patient is stupor/coma

Question 5

What are the five key components of DKA Tx?

Answer 5

Monitoring

***Fluid resuscitation

Insulin and dextrose infusion

Electrolyte repletion (potassium and magnesium)

Treating underlying cause

Question 6

What things should you monitor in DKA?

Answer 6

Glucose, lytes with calculated anion gap, Mag

BUN & creatinine, calculate GFR
Beta-hydroxybutyrate or serum ketones

UA

CBC

EKG, Cardiac status-cardiac enzymes

Infection-cultures, chest xray

Question 7

What is the initial Tx for DKA?

Answer 7

FLUID, FLUIDs, FLUIDS!!!

Deficits are typically 100 mL per kg

Fluid replacement will lower glucose

1L NS, 1L NS, 1L NS, then 500 mL NS x4 hrs, reasses, reassess

Once glucose below 250 => switch to D5W/.45% N saline

Question 8

Why do you need to think of potassium in DKA?

Answer 8

Acidosis increases K

Glucose + Insulin lowers K

Start K when K less than 5 mmol and adequate urine output

If initial K less than 3.3 mmol replete, and then start insulin when K above 3.3 mmol/L