DKA, HHS

Question 1

What are two of the most serious acute complications of DM

Answer 1

DKA and HHS

Question 2

DKA involves

Answer 2

Ketoacidosis and hyperglycemia

Question 3

HHS involves

Answer 3

more severe hyperglycemia without ketoacidosis

Question 4

DKA is more common in people

Answer 4

under 65

Question 5

DKA is associated with which type of DM

Answer 5

1

Question 6

can DKA occur with type 2?

Answer 6

under extreme conditions

Question 7

HHS is mostly associated with which type of DM

Answer 7

2

Question 8

HHS is more common in people aged

Answer 8

over 65

Question 9

extracellular concentration of glucose is regulated by

Answer 9

insulin and glucagon

Question 10

when serum glucose rises glucose enters

Answer 10

the pancreas initiating insulin release

Question 11

insulin restores normal glycemic levels by

Answer 11

diminishing hepatic glucose production
decreasing glycogenolysis and gluconeogenesis
increasing uptake by skeletal muscle and adipose tissue

Question 12

insulin deficiency and/or resistance is more severe in

Answer 12

DKA than HHS

Question 13

hyperglycemia

Answer 13

• serum glucose can exceed 1000
• glucose typically below 800 often 350-450 (these patients often present earlier with symptoms of ketoacidosis rather than HHS, tend to be younger and have higher GFR)
• glucosuria

Question 14

insulin deficiency and resistance cant get glucose into cells so the body uses

Answer 14

fat for energy (enhanced lipolysis in DK)

Question 15

lipolysis of peripheral fat stores releases

Answer 15

free fatty acids and glycerol

Question 16

fatty acids are transported to

Answer 16

liver and become acitvated

Question 17

activated fatty acids are converted to ____, and enter ketogenic metabolic pathway forming ____.

Answer 17

acetyl-CoA, ketone bodies

Question 18

accumulation of ketone bodies causes a drop in

Answer 18

pH

Question 19

DKA typically presents with

Answer 19

an elevated anion gap metabolic acidosis

Question 20

elevated anion gap metabolic acidosis is caused by

Answer 20

production and accumulation of ketones

Question 21

severity of acidosis and increase of anion gap factors is caused by

Answer 21

rate and duration of ketoacid production
rate and metabolism of ketoacids
rate and loss of ketoacid anions in urine

Question 22

plasma osmolality is always elevated in

Answer 22

DKA, HHS

Question 23

hyperglycemia pulls water out of cells, expanding ECF thus reducing

Answer 23

plasma sodium (dilutional hyponatremia)

Question 24

glucosuria causes osmotic diuresis leading to

Answer 24

excretion of sodium, potassium and water

Question 25

Both DKA and HHS present with total decreased

Answer 25

potassium levels, r/t increased urinary loss and GI loss

Question 26

serum potassium is usually high related to

Answer 26

hyperosmolality and insulin deficiency increased plasma osmolality causes water to move out of cells and potassium into ECF, insulin normally promotes potassium uptake by cells. Lack of insulin contributes to increased levels.

Question 27

increase in hydrogen concentration is seen with

Answer 27

acidosis (hydrogen moves into cell, K+ moves out, electrical neutrality is restored inside cells, and temporary correction of pH) process reverses as the pH returns to normal if kidneys are working, they excrete K+, can cause depletion of K+

Question 28

precipitating factors of DKA and HHS

Answer 28

- Infection (pneumonia or UTI) w/ w/o insulin correction - acute major illness or inflammation (MI, CVA, Sepsis, Pancreatitis) - new onset DM 1, (DKA common presentation) - drugs that affect carb metabolism (glucocorticoids, thiazide, dialectics) - SLG-2 inhibitors (DM 2 tx, DKA) - cocaine ( DKA) - poor insulin regimen

Question 29

DKA clinical presentation

Answer 29

- rapid onset (24 hours) - polyuria, polydipsia - N/V, abdominal pain - volume depletion (poor skin turgor, dry oral mucosa, -tachy, hypotension) - fruity odor to breath - kussmaul respirations

Question 30

HHS clinical presentation

Answer 30

insidious (several days) polyuria, polydipsia, WT loss as glucose increases lethargy, obtunded, coma signs of volume depletion similar to DKA

Question 31

treatment of DKA and HHS

Answer 31

fluid replacement correction of electrolyte imbalances insulin by infusion sodium bicarb (DKA with metabolic acidosis, pH <7.2)

Question 32

dextrose can be added to a saline solution when serum glucose falls below

Answer 32

200 mg/dl (DKA) if the patient still has an anion gap) | while pt on continuous insulin infusion

Question 33

the DKA hyperglycemic crisis is resolved when

Answer 33

``` ketoacidosis resolves (anion gap is closed) and patient is able to eat and can transition back to SQ insulin ```

Question 34

the HHS hyperglycemic crisis is resolved when

Answer 34

patient is mentally alert and plasma osmolality has dropped to 315 and patient is able to eat and can transition back to SQ insulin

Question 35

DKA is a condition of ketones in

Answer 35

the blood and metabolic acidosis leading to anion gap, and hyperglycemia associated with insulin deficency.

Question 36

what are common causes of DKA?

Answer 36

lack of adherence to insulin and/or physiologic stress

Question 37

how do you treat DKA

Answer 37

treat volume depletion rapidly with 0.9% NS, supplements K+ as needed, IV infusion of insulin

Question 38

what do you monitor in DKA?

Answer 38

glucose, electrolyte levels, anion gap

Question 39

HHS is defined by

Answer 39

marked hyperglycemia, dehydration, electrolyte imbalance, and hyperosmolality

Question 40

which has a higher mortality rate HHS or DKA?

Answer 40

HHS

Question 41

What can cause HHS

Answer 41

``` pneumonia UTI insulin deficiency inflammatory conditions MI Stroke Severe dehydration drugs ```

Question 42

how do you treat HHS

Answer 42

treat volume depletion with rapid NS IV insulin Correct electrolyte imbalance