DKA / HONK

Question 1

What is the definition of DKA

Answer 1

Hyperglycemia - either as a presentation or a complication of T1 Diabetes

Question 2

What are the features of DKA?

Answer 2

1. Ketones >3mmol or +++ in urine
2. Acidosis pH <7.3
3. Hyperglycemia >11mmol / unknown

Question 3

presentation of DKA

Answer 3

1. Polyurea
2. Polydispea
3. Decreased GCS
4. Dehydration
5. Abdopain
6. Vomiting
7. Weight loss
8. Increased resp rate (Kusmalls breathing)
   9 Pear Drop breath

Question 4

What are the causes of DKA

Answer 4

1. infection
2. Surgery
3. Non compliance
4. Newly diagnosed (I.e. this is the presentation)

Question 5

What are the investigations for DKA

Answer 5

Bloods

1. FBC, U&E, LFTs
2. Glucose
3. Septic screen
4. Amylase (for abdominal pain)

Bedside:

1. ABG
2. ECG
3. Urine Dip

Imaging
1. CXR

Question 6

What is the treatment of DKA

Answer 6

Essentially Re-hyrdration

1. 1L in 1hr
2. 1L in 2hr + K+
3. 1L in 2hr + K+
4. 1L in 4hr + k+

Start insulin infusion 50 IU in 500ml (0.1 U / kg / hr)

Question 7

When do you start giving glucose in DKA

Answer 7

when the glucose has come down to 15mmol give 5% glucose with saline

Question 8

When should you stop giving K+

Answer 8

if the urine output gets to <30ml / hr or K+ is >5.5

Question 9

What is the definition of HONK

Answer 9

Hyperosmolar Non ketotic acidosis in T2DM

Question 10

What are the presenting features of HONK

Answer 10

Gradual dehydration and increase in glucose over the course of 1week

• Hyperosmolar >340mmol
• Hyperglycemia >32mmol
• Polyuria
• Polydipsia
• low GCS

Question 11

Causes of HONK

Answer 11

• Poor compliance
• Polydipsia
• Low GCS

Question 12

Treatment of HONK

Answer 12

1. Fluid replacement
   - 1L / 1hr
   - 1L / 2hr + k+
   - 1L / 2hr + k +
   - 1L / 4hr + k+

The average loss is about 8L which needs replacing over 48hrs

2. Insulin infusion. When glucose reaches 15mmol STOP and start glucose infusion and monitor (at this point the body’s insulin takes over)

Question 13

Definition of hypoglycaemia

Answer 13

plasma glucose <3mmol

Question 14

What are the 3 diagnostic features of hypoglycaemia

Answer 14

Whipples triad

• Low glucose
• Symptoms of low glucose
• Resolution of symptoms on ingestion of glucose

Question 15

Signs of hypoglycaemia (Autonomic and neurological)

Answer 15

Autonomic (<3.6)

• Sweating
• palpitations
• anxiety
• hunger
• tremor

Neurological

• Low GCS
• Siezures
• Coma / Drowsy
• Hemiparesis

Question 16

Types of hypoglycemia

Answer 16

Fasting and post prandial

Question 17

Treatment of hypoglycaemia

Answer 17

Glucose!

• If conscious give oral glucose e.g. sugar or lucazade
• if unconscious and at home give IM glucagon
• If unconscious and in hospital give IV glucose 10%