DKA ONLY SARA

Question 1

What are the diagnostic criteria for Diabetic Ketoacidosis (DKA)?

Answer 1

Hyperglycemia: Blood glucose level greater than 200-250 mg/dL.Ketonemia: Blood ketone level greater than 3.0 mmol/L.Metabolic Acidosis: pH less than 7.3 and HCO3 less than 15-18 mmol/L.

Question 2

What are the common symptoms and signs of DKA?

Answer 2

Symptoms: Thirst, polyuria, nausea, vomiting, abdominal pain, and shortness of breath.Physical findings: Dehydration, hypotension, abdominal tenderness, lethargy, and possible coma.

Question 3

What are the precipitating factors for DKA?

Answer 3

Non-compliance with treatment and non-availability of insulin.Increased carbohydrate intake, stress, trauma, and infections.

Question 4

What types of ketones are associated with DKA?

Answer 4

Acetone: Detected in breath.Acetoacetic acid: Detected in urine.Beta-hydroxybutyric acid: Detected in blood.

Question 5

How can capillary ketone levels be interpreted?

Answer 5

Normal: Less than 0.6 mmol/L.Moderate: 0.6 to 1.5 mmol/L - retest in a few hours.High: Greater than 1.6 to 3.0 mmol/L - risk of ketoacidosis.

Question 6

What are the potential complications of DKA?

Answer 6

Cerebral edema, especially in children.Myocardial infarction and infections (30-40% risk).

Question 7

What are the metabolic changes observed in DKA?

Answer 7

Increased blood ketone levels leading to acidosis.Electrolyte imbalances, particularly hypokalemia.

Question 8

What is the definition of Diabetic Ketoacidosis (DKA)?

Answer 8

A biochemical diagnosis characterized by a triad of hyperglycemia, ketonemia, and metabolic acidosis.Commonly occurs in individuals with diabetes, particularly type 1 diabetes.

Question 9

What are the initial steps in managing DKA?

Answer 9

Rapid ABC (Airway, Breathing, Circulation).Insert a large bore IV cannula and start IV fluid replacement.Conduct a clinical assessment including respiratory rate, temperature, blood pressure, pulse, and oxygen saturation.Evaluate Glasgow Coma Scale, especially for drowsy patients requiring critical care.

Question 10

What investigations are necessary for a case of DKA?

Answer 10

Capillary blood glucose measurement.Venous blood gases analysis.Venous plasma glucose testing.Urinalysis and culture if needed.Blood cultures and serum lactate if sepsis is suspected.Chest radiograph and ECG for symptomatic patients.

Question 11

What are the clinical severity criteria for DKA?

Answer 11

Glasgow Coma Scale (GCS) less than 12.Oxygen saturation below 92% on room air.Pulse rate over 100 or below 60 bpm.Presence of organ failure, sepsis, or severe illness.Blood ketones over 6 mmol/L and bicarbonate level below 5 mmol/L.Venous/arterial pH below 7.1.

Question 12

What is the summary of treatment for DKA?

Answer 12

Confirm DKA and ensure ABCs are stable.Establish two large IV lines for fluid resuscitation.Continue long-acting insulin at the same dose.Implement intensive monitoring every hour.Look for underlying causes, usually infections.Restore circulation volume and clear ketones.

Question 13

What laboratory tests are important in DKA management?

Answer 13

Renal function tests and electrolytes.Monitor for hypokalemia on admission (under 3.5 mmol/L).Calculate anion gap to assess metabolic acidosis.IV fluids at a rate of 100ml/kg/24 hours.IV potassium chloride as per potassium levels.IV insulin at a fixed dose of 0.1 units/kg/hour.

Question 14

What are the key components of intensive monitoring in DKA?

Answer 14

Monitor input and output hourly.Check vital signs including blood pressure and heart rate.Assess urine output for signs of renal perfusion.Evaluate laboratory results for electrolytes and glucose levels.Adjust treatment based on clinical status and lab findings.

Question 15

What are the new changes in the management of DKA over the last two decades?

Answer 15

Measurement of blood ketones and venous pH as treatment markers.Replacing sliding scale insulin with weight-based fixed rate intravenous insulin infusion.Monitoring electrolytes with blood gas analyzers and laboratory confirmation.

Question 16

What is the recommended fluid management for DKA patients?

Answer 16

Initial fluid of choice is 0.9% saline, with specific volumes based on patient weight.After initial resuscitation, switch to 0.45% saline to prevent complications.Monitor urine output and adjust fluid replacement accordingly.

Question 17

How should potassium levels be managed in DKA treatment?

Answer 17

Regular monitoring of serum potassium is essential due to the risk of hypokalemia.Potassium replacement is based on levels: over 5.5 mmol/L requires careful infusion, while below 3.5 mmol/L needs senior review.

Question 18

What role does a diabetes specialist team play in DKA management?

Answer 18

Involvement is crucial if the patient does not improve within 24 hours.They provide specialized care and adjustments to treatment plans as needed.

Question 19

What are the key considerations for insulin administration in DKA?

Answer 19

Continuation of long-acting insulin analogues is recommended.Insulin should be delayed until potassium levels are above 3.3 mmol/L to avoid complications.

Question 20

What are the risks associated with potassium levels in DKA patients?

Answer 20

Hypokalemia and hyperkalemia are life-threatening and common in DKA.Serum potassium may be high initially but can drop rapidly with insulin treatment.

Question 21

What is the significance of monitoring blood ketones in DKA management?

Answer 21

Blood ketones help assess the severity of DKA and guide treatment decisions.They are crucial for determining the effectiveness of ongoing therapy.

Question 22

What is the importance of using venous blood in DKA management?

Answer 22

Venous blood is preferred over arterial blood for blood gas analysis.This change simplifies the process and reduces patient discomfort.

Question 23

How should fluid replacement be adjusted after stabilizing blood pressure in DKA patients?

Answer 23

Once SBP is above 90 mmHg, fluid replacement should be tailored based on ongoing assessments.Continue monitoring and adjust fluids to maintain hydration and electrolyte balance.

Question 24

What are some poor prognostic factors in critical illness?

Answer 24

Extreme ageSevere critical illnessesMultiple comorbidities

Question 25

What is the recommended insulin therapy approach for mild to moderate DKA?

Answer 25

Use rapid-acting insulin therapyAdminister bolus if blood glucose exceeds 250 mg/dL

Question 26

What are the signs that indicate the need for insulin therapy in DKA?

Answer 26

Blood glucose levels above 250 mg/dLPresence of hypothermia or hypotension

Question 27

What is the protocol for administering insulin in DKA management?

Answer 27

Start with a bolus of rapid insulinContinue insulin until blood glucose levels are below 250 mg/dL

Question 28

What are the key considerations for insulin therapy in non-ICU settings?

Answer 28

Monitor blood glucose levels regularlyAdjust insulin dosage based on blood glucose readings

Question 29

What are the key monitoring steps during DKA?

Answer 29

Hourly glucose testingVitals monitoring hourly initiallyIntake and output record

Question 30

What are the treatment targets during DKA?

Answer 30

Ketones should drop by 0.5mmol per hourBicarbonate should rise by 0.5-1 mmol per hour

Question 31

What actions should be taken once glucose levels drop below 250mg/dl?

Answer 31

Add D10% 500ml at 80-125ml/hour ((( D5 ??)))

Continue hourly glucose testing

Target glucose levels between 150-200mg/dl

Question 32

What should be done if a patient is not improving during DKA protocol?

Answer 32

Check patency of IV linesAssess fluid status and provide more fluidsCheck insulin pump settingsLook for underlying etiology, such as possible infection

Question 33

What criteria indicate a patient is out of DKA?

Answer 33

Blood ketones less than 0.6mmol/lNormal anion gap <12pH more than 7.3Able to eat and drink

Question 34

What is the recommended insulin infusion rate for DKA treatment?

Answer 34

Weight-based insulin at 0.1 units/kg/hourAdjust based on blood glucose levels

Question 35

What should be monitored in terms of glucose levels during DKA treatment?

Answer 35

Glucose should drop by 3-4mmol/I per hourMaintain glucose levels between 150-200mg/dl

Question 36

What is the maximum insulin infusion rate during DKA?

Answer 36

Maximum of 15 units/hourEnsure weight-based dosing is followed

Question 37

What adjustments should be made if blood glucose levels fall below 150mg/dl?

Answer 37

Increase D10% infusionContinue monitoring glucose levels hourly

Question 38

What should be done if blood glucose levels exceed 200mg/dl during DKA treatment?

Answer 38

Reduce D10% infusion rateContinue to monitor glucose levels closely

Question 39

What are the criteria for shifting to subcutaneous insulin in a patient with DKA?

Answer 39

If already on basal bolus insulin, continue the same dose and time while adjusting as needed.Once ketones are less than 0.6 mmol/L and pH is more than 7.3, administer subcutaneous bolus insulin before meals and stop all IV insulin after 1 hour.

Question 40

How should insulin be started in a newly diagnosed diabetic patient with DKA?

Answer 40

Initiate basal bolus insulin therapy based on weight, typically starting at 0.5 units/kg/day.If the patient is on twice-daily mixed insulin, calculate the total daily dose and transition to basal bolus for improved control after education.

Question 41

What steps should be taken for a patient on an insulin pump after DKA treatment?

Answer 41

Recommence the insulin pump at the normal basal rate.Continue intravenous insulin infusion until the meal bolus is administered, and do not restart the pump at bedtime.

Question 42

What monitoring is essential for a patient post-DKA while still hospitalized?

Answer 42

Conduct glucose testing pre-meal, 2 hours post-meal, and at 3 AM.Monitor blood ketones twice or three times daily if possible, and maintain an intake-output record.

Question 43

What aftercare measures should be taken to prevent DKA recurrence at home?

Answer 43

Patients should be discharged on subcutaneous insulin tailored to their needs and circumstances.Ensure patients receive diabetes education and arrange for early follow-up with the diabetes team.

Question 44

What are the complications and precipitating factors of DKA?

Answer 44

Complications include rebound DKA due to premature cessation of insulin therapy and potential mortality, which is now below 1% with modern management.Other factors include severe acidosis, hypokalemia, and dehydration.

Question 45

What is the treatment summary for managing DKA?

Answer 45

Continue long-acting insulin at the same dose and time as an option.Monitor for rebound ketoacidosis and adjust IV fluids if there is poor intake, using half saline with potassium as needed.

Question 46

What are the indications for administering bicarbonate in cases of severe acidosis?

Answer 46

pH < 6.9 indicating severe acidosis.

BICARBONATE < 5.

Resistant diabetic ketoacidosis (DKA) after fluid resuscitation.

Life-threatening hyperkalemia.

Question 47

What are the potential side effects of carbohydrate therapy in DKA treatment?

Answer 47

Increased sodium (PNa) levels.Volume overload leading to complications.Delayed ketone clearance.

Question 48

What complications can arise from fluid overload in children with DKA?

Answer 48

Cerebral edema, which is particularly dangerous in children.Increased intracranial pressure.

Question 49

What is the recommended timeframe for monitoring after successful DKA protocol?

Answer 49

Continuous monitoring for 2-4 hours post-protocol.Assessment of electrolyte levels and overall stability.

Question 50

What is the significance of CSF acidosis in the context of DKA?

Answer 50

It indicates a severe metabolic disturbance.Can contribute to neurological complications.