DKA Vignette

Question 1

DKA Symptoms

Answer 1

Acutely Ill appearing, labored deep breathing, dehydrated, thin, N, V, AbP, increased urination

Hyerglycemia, Acidosis, ketonuria/ketonemia

Question 2

Metabolic Disturbances in DKA (4)

Answer 2

Elevated blood glucose (>200mg/dL) from loss of betas

Acidosis: blood pH5.8mEq/L, Dehydration causes body to hold Na but lose K from antiporter in kidney. Acidosis increases H intake so K is lost. Hyper in blood but Hypo in cells

Dehydration: osmotic loss of fluid from hyperglycemia, too much glucose to be reabsorbed in kidneys causes increased water loss

Question 3

Insulin Release Stimulus

Answer 3

Glucose enters beta cells passively, glycolysis occurs with glucokinase as rate limiting step, ATP is made and causes K channels to close, depolarization causes calcium to enter via voltage gated channels, binds synaptotagmin and causes release of insulin-filled vesicles

Question 4

Cellular Targets of Insulin (3)

Answer 4

Muscle: +glucose uptake, glycogen synthesis, protein synthesis
Liver: +glucose uptake, glycogen synthesis, lipid synthesis, - gluconeogenesis and ketogenesis
Adipose: +glucose and triglyceride uptake, lipid synthesis

Question 5

Cerebral Edema Risk

Answer 5

Hyperglycemia and dehydration occur at equal rates in blood and brain. Adding IV fluid too quickly will transfer fluid to brain because insulin acts faster on blood glucose than brain so osmolarity in brain will be higher.

Treat with Mannitol

Symptoms: confusion, HA, combative, bradycardia, fixed pupils

Question 6

Type I Diabetes

Answer 6

Loss of insulin producing beta cells likely 2’ to autoimmune condition