DKA/HHS

Question 1

Which has more severe hyperglycemia? DKA or HHS

Answer 1

HHS

Question 2

DKA or HHS?
More common under 65, associated with type one diabetes, rare with type two

Answer 2

DKA

Question 3

DKA or HHS?
Common with type two diabetes, more common with people over 65 years old

Answer 3

HHS

Question 4

DKA often present earlier with symptoms of Keto acidosis, such as

Answer 4

Shortness of breath, abdominal pain, nausea, vomiting

Question 5

Ketone production

Answer 5

Insulin deficiency in resistance
Can not get glucose in the cells, So body uses fat for energy (lipolysis)
Release of fatty acids and glycerol
Fatty acids transported to liver and become activated
Fatty acids been converted to acetyl-CoA, forming ketone bodies
Accumulation of ketone bodies causes a drop in pH (metabolic acidosis)

Question 6

Does DKA or HHS typically present with an elevated anion gap

Answer 6

DKA

Question 7

Severity of acidosis and increase of anion gap depends on

Answer 7

Read induration of keto acid production, rate of metabolism of keto acids, rate of loss of ketoacid anion in urine

Question 8

Glucosuria Causes automatic diuresis leading to

Answer 8

Excretion of sodium, potassium, and water

Question 9

Do DKA and HHS have hyper or hypo kalemia?

Answer 9

Hypokalemia
This is due to increased urinary loss, or G.I. losses

Question 10

What are some precipitating factors for DKA or HHS

Answer 10

In section without insulin adjustment, acute major illness or inflammatory process, new onset of type one diabetes, drugs that affect carbohydrate metabolism, use of SGL T2 inhibitors, substance abuse, poor compliance with insulin regimen for faulty SQ insulin infusion devices

Question 11

How does a patient with DKA present

Answer 11

There’s a rapid onset
polyuria, polydipsia, GI Effects like nausea, vomiting, abdominal pain,
may have neurological effects (Combative, drunk like, coma)
volume depletion (And decreased skin turgor, dry oral mucosa, tachycardia, hypotension),
Fruity odor of breath, Kussmaul respirations

Question 12

HHS clinical presentation

Answer 12

Insidious onset of polyuria, polydipsia, and weight loss over several days
As glucose continues to increase patient becomes lethargic, obtunded, or comatose
Signs of volume depletion occur, similar to DKA

Question 13

Treatment of decay and HHS

Answer 13

Fluid replacement, correction of electrolytes, insulin infusion, sodium by carbonate (DKA), And dextrose may be added to saline solution if patient still has an anion gap

Question 14

What does it look like when DKA is resolved?

Answer 14

Keto acidosis has resolved in the anion gap has closed. Patient is able to eat and can transition back to subcutaneous insulin

Question 15

What does it look like when HHS has resolved?

Answer 15

Patient is mentally alert and plasma osmolality has dropped to 315. Patient is able to eat and can transition back to subcutaneous insulin

Question 16

What are common causes of DKA?

Answer 16

Lack of adherence to insulin doses or physiologic stressors

Question 17

What do you monitor with DKA?

Answer 17

Glucose, electrolyte level, anion gap

Question 18

DKA is a condition of

Answer 18

Ketones in the blood, metabolic acidosis leading to anion gap, and usually hyperglycemia associated with insulin deficiency

Question 19

HHS definition

Answer 19

Marked hyperglycemia, dehydration, electrolyte imbalance, and hyper osmolality

Question 20

What has a higher mortality rate DKA or HHS

Answer 20

HHS

Question 21

What can lead to HHS

Answer 21

Symptoms of illness such as pneumonia, UTI, insulin deficiency, inflammatory condition, am I, stroke, severe dehydration, and the use of some drugs