DKA/HHS

Question 1

DKA

Answer 1

ketones in blood
Metabolic acidosis – anion gap
Hyper glycemia with insulin deficiency

Question 2

Who is DKA more common in?

Answer 2

under 65 years
Type one diabetes

Question 3

HHS

Answer 3

Marked hyperglycemia
Dehydration, electrolyte imbalance
Hyper osmolality
No ketoacidosis

Question 4

Who does HHS occur more in?

Answer 4

over 65
Type two diabetes

Question 5

response to hyperglycemia

Answer 5

Extracellular concentration of glucose is regulated by insulin and glucagon

When serum insulin increases glucose goes to the pancreas to initiate insulin release

Insulin restores normal glucose by decreasing hepatic production, gluconeogenesis, glycogenolysis

Increased glucose uptake by skeletal muscles and Adipose tissue

Question 6

Patho of hyperglycemia

Answer 6

Decreased insulin or resistance

Increased catecholamines and cortisol – increased hepatic production

Dehydration and electrolyte abnormalities

Question 7

hyperglycemia with HHS

Answer 7

Serum glucose greater than 1000

Glucosuria results from osmotic diuresis

Question 8

hyperglycemia with DKA

Answer 8

Serum glucose less than 800, 350 to 450

Presents earlier with symptoms of ketoacidosis

Tends to be with younger patients with increased GFR

Question 9

ketone production

Answer 9

Insulin deficiency in resistance – cells. Use fat for energy

Lipolysis of peripheral fat stores, releases free fatty acids and glycerol

free fatty acids go to the liver to become activated

Activated free Fatty acids convert to acetyl coA– ketone bodies

Ketone bodies decrease pH – metabolic acidosis

Question 10

why doesn’t ketone production occur with HHS?

Answer 10

Patient still can produce some insulin to minimize lipolysis

Question 11

anion gap

Answer 11

Occurs with DKA

Caused by production and accumulation of ketones

Question 12

what is the severity of acidosis within anion gap depend on?

Answer 12

Rate and duration of keto acid production

Rate of metabolism of keto acids

Rate of loss of ketoacid anions in urine

Question 13

is plasma osmolality increased or decreased with elevated glucose?

Answer 13

Increased

Hyperglycemia pulls water out of cells results in decreased plasma, sodium-dilutional hyponatremia

Question 14

how is plasma osmolality affected by glycosuria?

Answer 14

Decreased from osmotic diuresis

Excretion of sodium, potassium, water

Question 15

potassium

Answer 15

Decreased with both DKA & HHS

Increased urinary loss, G.I. loss

Question 16

Cellular compensation

Answer 16

H+ moves into the cell
K+ moves out of the cell

Question 17

precipitating factors

Answer 17

Infection – pneumonia, UTI
Acute major illness – MI, CVA, sepsis, pancreatitis
New onset type one diabetes, DKA
Drugs – glucocorticoids, thiazide, diuretics
SLG T2, inhibitors
Cocaine/substance use
Poor compliance with insulin regimen

Question 18

DKA s/sx

Answer 18

rapid, 24 hours
Polyuria, polydipsia
N/V/abdominal pain
Fruity odor breath **
Kussmaul respirations **
Neuro effects
Decrease volume – decrease skin turgor, drymucosa, tachycardia, hypotension

Question 19

HHS s/sx

Answer 19

insidious – several days
Polyuria, polydipsia
Decreased weight

As glucose increases, – lethargy, obtunded, coma**

s/sx fluid volume deficit

Question 20

treatment

Answer 20

Fluid replacement, rapid-isotonic saline
correct fluid and electrolyte imbalance
Administer insulin by infusion

Sodium bicarb – DKPH less than 7.2

Dextrose added to fluids, if glucose less than 200 with anion gap

Question 21

how to know if DKA is resolved

Answer 21

Keto acidosis is gone
Anion gap closed

Monitor fluid and electrolyte, glucose, anion gap

Question 22

how to know if HHS is resolved

Answer 22

Patient is mentally alert
Plasma osmolality greater than or equal to 315

Patient is able to eat in transition to sub Q insulin