DKA-pino

Question 1

DKA

Diagnosis

Answer 1

Hyperglycemia (>200)

Acidosis (pH<7.3 or bicarb < 15)

Ketosis-ketonemic, ketonuria

Question 2

DKA

Tx

Answer 2

1st! IV fluids

2nd: insulin

NOT BICARB (usually)

Question 3

DKA

Therapy

Answer 3

Treat shock first

Normal saline initial fluid of choice

Bolus: hypotensive, tachy (shock): correct fast

10 mL/kg over an hour if not shock 20 ASAP if shock

Question 4

DKA therapy

Glucose

Answer 4

Can’t stop insulin (drive glucose in cell)

Must give glucose to be able to keep giving glucose

Question 5

Sodium

Answer 5

False hyponatremia

Hiding 1.6mEq/100BS

So really could have normal na

As blood sugar drops, na should come up

Question 6

Potassium

Answer 6

Add when K < 5.5

Question 7

Insulin

Therapy

Answer 7

Stop pump!

GIVE ONLY IV INSULIN (not bolus)

NEVER STOP INSULIN INFUSION

Question 8

DKA

Complications

Answer 8

Cerebral edema

Osmol serum= 2Na + glucose/18 + BUN/2.8

280-300 normal

Question 9

Cerebral edema

Tx

Answer 9

Mannitol, hypertonic saline, ventilation

Prevention is best

Question 10

Degree of edema

Answer 10

May correlate with dehydration, hyperventilation at presentation

Question 11

Cerebral edema

Risk

Answer 11

Younger

New onset

Longer duration of sx

Question 12

DKA

Presents in…

Answer 12

Kids commonly

Around 5 and then again around 15