DKA/HHS

Question 1

underlying metabolic abnormality of DKA/HHS

Answer 1

absolute or relative insulin deficiency

Question 2

counterregulatory hormones of DKA

Answer 2

glucagon, catecholamines, cortisol

Question 3

role of hypercortisolemia in DKA

Answer 3

caused proteolysis (provides amino acid precursors for gluconeogenesis)

Question 4

what is the effect of catecholamines on insulin sensitivity

Answer 4

decreases insulin sensitivity

Question 5

mechanism of hyperglycemia in DKA/HHS

Answer 5

low insulin > elevated glucagon > elevated hepatic glucose production > decreased peripheral glucose use

Question 6

which enzyme is activated in DKA and causes breakdown of triglycerides and release of FFA?

Answer 6

hormone-sensitive lipase

Question 7

where are FFA converted to ketone bodies

Answer 7

liver

Question 8

where does beta oxidation of FFA take place within the cell

Answer 8

mitochondria

Question 9

product of the beta oxidation pathway

Answer 9

acetyl CoA

Question 10

what ketoacids are made from acetyl CoA

Answer 10

acetoacetate

b hydroxybutyrate

Question 11

what is acetone converted from

Answer 11

acetoacetic acid

Question 12

which ketone is measured in the urine

Answer 12

acetoacetic acid

Question 13

which ketoacids cause the anion gap in DKA?

Answer 13

b hydroxybutyric acid

acetoacetic acid

Question 14

fluid deficit in DKA

Answer 14

5-7L

Question 15

fluid deficit in HHS

Answer 15

7-12L

Question 16

potassium deficit in DKA/HHS

Answer 16

3-6mEq/kg

70kg = 300-500 mEq

Question 17

fastest rate of peripheral IV potassium replacement

Answer 17

10 mEq/hr

Question 18

fastest central line potassium replacement

Answer 18

20 mEq/hr

Question 19

definition of HHS

Answer 19

serum osm > 320, pH > 7.30

Question 20

treatment of DKA/HHS

Answer 20

fluids
potassium
insulin

Question 21

fluid deficit should be corrected within how many hours

Answer 21

24

Question 22

insulin should be withheld if potassium drops below what value

Answer 22

3.3

Question 23

potassium should be replaced once level drops below what value in DKA

Answer 23

5.0

Question 24

role of bicarbonate therapy in DKA

Answer 24

if pH < 7.0

Question 25

role of phosphate replacement in DKA

Answer 25

theoretical benefit

Question 26

mechanism of cerebral edema in DKA treatment

Answer 26

idiogenic osmoles take time to dissapate; rapid fluid correction; insulin therapy leads to entry of osmotically active particles into the cell