DKA Vignette I

Question 1

DKA is defined as

Answer 1

hyperglycemia, metabolic acidosis, and ketonemia/ketonuria.
D (diabetes, which is defined as abnormally high blood sugar),
K (ketones in the blood and urine),
A (acidosis).

Question 2

metabolic threats to this patient include

Answer 2

hyperglycemia, metabolic acidosis, hyperkalemia (which can potentially devolve into hypokalemia if you are not careful in your management), and dehydration

Question 3

Insulin is

Answer 3

a 51 amino acid protein released by the beta cells of the pancreas

Question 4

In type 1 diabetes mellitus,

Answer 4

an incompletely understood autoimmune process leads to destruction of these beta cells and results in insulin deficiency.

Question 5

Insulin release is regulated by a _______ within the _______

Answer 5

glucose sensing system

beta cells

Question 6

glucose enters the cell through the _______, undergoes _______, leading to an increase in the intracellular _______ to _______ ratio.

Answer 6

GLUT2 transporter
glycolysis
ATP
ADP

Question 7

The increase in the intracellular ATP and ADP ratio closes the _______, preventing _______

Answer 7

ATP-sensitive potassium channel

outward leak of potassium ions

Question 8

The resultant buildup of intracellular potassium (because there are other sodium/potassium channels actively antiporting against the gradient) _______ the membrane, activating a _______ and leading to _______

Answer 8

depolarizes
voltage-gated calcium channel
calcium influx

Question 9

The increased intracellular calcium ion concentration leads to

Answer 9

exocytosis of preformed insulin-containing secretory granules

Question 10

Once released from the beta cell into the bloodstream, human insulin has a half-life of about _______, allowing for _______

Answer 10

5 minutes

minute-by-minute fine control of blood sugar

Question 11

Insulin stimulates uptake of _______ and _______ while promoting synthesis of _______, _______, and _______

Answer 11

glucose
triglycerides
fats
proteins
glycogen

Question 12

Insulin actions: Liver

Answer 12

+ glucose uptake, glycogen synthesis
- gluconeogenesis
- ketogenesis
+ lipogenesis

Question 13

Insulin actions: Muscle

Answer 13

+glucose uptake, glycogen synthesis

+protein synthesis

Question 14

Insulin actions: Adipose

Answer 14

+glucose uptake
+triglyceride uptake
+lipid synthesis

Question 15

The intravenous insulin serves two purposes:

Answer 15

decreasing the blood glucose concentration and halting ketoacid production

Question 16

Two cardinal sins in DKA management are

Answer 16

prematurely stopping the insulin infusion and failing to use enough dextrose to bring the blood glucose slowly into the target range.

Question 17

The acidosis seen in DKA is a result of

Answer 17

beta oxidation of fatty acids

Question 18

the beta oxidation of fatty acids generates

Answer 18

hydrogen ions and ketone bodies (acetoacetate and betahydroxybutyrate)

Question 19

To compensate for the excess acid, the body increases _______e and rate to _______

Answer 19

• respiratory volume and rate

- hasten the elimination of carbon dioxide

Question 20

_______ is very membrane permeable and readily removed from the body at a rate dependent on the volume of air ventilated per unit of time (usually discussed as
“minute ventilation,” and dependent on respiratory rate and the volume of air exhaled with each breath).

Answer 20

CO2

Question 21

CO2 is very membrane permeable and readily removed from the body at a rate dependent on the _______ and dependent on _______

Answer 21

volume of air ventilated per unit of time (usually discussed as
“minute ventilation,” and dependent on respiratory rate and the volume of air exhaled with each breath)

Question 22

The deep and rapid respirations seen in DKA are “_______.”

Answer 22

Kussmaul respirations

Easy to remember: K for Kussmaul, K for ketoacidosis

Question 23

The dehydration seen in DKA is largely the result of

Answer 23

the osmotic diuresis secondary to hyperglycemia

Question 24

In the normal state, blood is filtered at the _______, and as the filtrate courses through the _______, the _______ reabsorbs all the glucose filtered.

Answer 24

glomerulus
nephron
parsimonious kidney

Question 25

in diabetes the blood glucose (and therefore filtrate glucose) concentration _______(all the transporter proteins are working at capacity), and glucose is _______.

Answer 25

• rises above levels which can be reabsorbed through facilitated diffusion
• lost in the urine

Question 26

With an excess of _______ (and therefore osmols) in the filtrate, the body is unable to _______. Therefore, _______

Answer 26

• glucose
• reabsorb as much water as it would under normal conditions
• large volumes of water are lost in the urine, even in the setting of dehydration

Question 27

as the blood ketoacid concentration rises, the patient experiences _______ and _______, making it even more difficult for oral intake to keep up with urine volume loss, resulting in _______

Answer 27

• nausea
• vomiting
• dehydration

Question 28

dehydration leads to an _______, worsening the pace of the _______, a spiral that can often only be reversed with _______

Answer 28

• even further concentration of blood glucose,
• osmotic diuresis
• IV hydration