DKA Vignette

Question 1

Diagnose Diabetes

Answer 1

Hb1AC > 6.5% or
Fasting plasma glucose > 200 mg/dL or
Random plasma glucose > 200 mg/dl in pt. w/ symptoms of hyperglycemia

Question 2

DKA definition

Answer 2

Hyperglycemia (>200)
Metabolic acidosis (pH < 7.3 and/or HCO3 < 15)
Ketoniemia/kenonuria

(D= diabetes, K- ketones, A- acidosis).

Question 3

Glucose/Insulin

Answer 3

1. ) Glucose taken up by Glut2 transporter
2. ) Glycosis leads to increased ATP:ADP ratio
3. ) ATP sensitive K channel closes
4. ) Intracellular K builds up
5. ) Membrane depolarizes
6. ) Activate voltage gated Ca channel
7. ) Ca influx
8. ) Increased Ca levels in the cell
9. ) Exocytosis of insulin granules

Question 4

Insulin actions

Answer 4

Uptake of glucose/triglycerides, promote fat/protein/glycogen syntehsis
Decrease gluconeogenesis and ketogenesis in liver

INSULIN STORES ENERGY (make glycogen, protein, and fat).

Question 5

Insulin deficiency

Answer 5

Glucose can’t be taken into cells, hyperglycemia.

Body needs another source of energy: lipolysis, fatty a oxidation by liver, ketoacid production

Question 6

Ketoacidosis

Answer 6

Beta oxidation of FA’s produces H ions and ketones.

To compensate for acid body increases respiratory volume and rate to hasten Co2 elimination.

Question 7

Kussmaul respirations

Answer 7

DKA. Way for body to compensate for acids by decreasing Co2.

Question 8

Dehydration in DKA

Answer 8

because there is excess glucose (increased osmolarity of filtrate) body can’t resorb as much h20 as usual, so lots of H20 is lost even with dehydration.

Question 9

Potassium derangements in DKA

Answer 9

Body compensates for dehydration by holding onto sodium, which is at expense of K
Acidosis also leads to influx of H into cells, so K is effluxed (so you see hyperkalemia despite overall depletion).
Insulin can cause K to shift into ICF lowering blood levels.

Question 10

Plan

Answer 10

Hyperglycemia: IV fluids (dilution), insulin
Dehydration: give isotonic IV fluids
Acidosis: insulin, stop ketone formation. Fluids (urinary excretion of acids and ketones).
Potassium: need lots of K carefully

Question 11

Cerebral edema

Answer 11

mental status change, headaches, hypertension bradycardia irregular respirations (cushing’s triad), fixed dilated pupils.
Mannitol can help by increasing osmolality of blood and pulling fluid from brain.