DKA1

Question 1

What is the likely diagnosis for a patient who has a history of congestive heart failure and presents with shortness of breath? What are the expected abnormal vital signs?

Answer 1

Acute decompensation heart failure; high blood pressure and high respiratory rate

Question 2

How do patients with CHF exacerbation present?

Answer 2

Months of progressive increasing shortness of breath that has acutely worsened over the last day or so, now experiences SOB at rest

Question 3

How does the cough present in acute decompensation heart failure?

Answer 3

Mild cough with deep inspiration, pink frothy sputum

Question 4

What are the vital signs for a patient who has DKA?

Answer 4

Hypotension, tachycardia, tachypnea, rapid and shallow breathing, febrile

Question 5

What with the chief complaint for a patient who has DKA?

Answer 5

Abdominal pain ass. with vomiting

Question 6

What are the associated symptoms with DKA?

Answer 6

The drowsiness and weakness LOC confusion, Deep gasping breathing, Along with classic diabetes symptoms such as polydipsia, polyuria etc.

Question 7

What should be examined DKA patient?

Answer 7

General HENT, neck, heart, lungs, abdomen, extremities

Question 8

What are the positive physical examination findings for DKA?

Answer 8

Weak peripheral pulses along with diffuse abdominal pain, dry mucus membranes

Question 9

What are the differential diagnoses for abdominal pain with vomiting?

Answer 9

Abdominal pathology, menstrual symptoms or pregnancy related complications, DKA, nonketotic Hyperosmolar state, alcoholic ketoacidosis, drug intoxication

Question 10

What is alcoholic ketoacidosis?

Answer 10

Metabolic acidosis caused by increased Ketone levels. Glucose concentrations are usually normal or a little low. Increase catecholamines leads to the breakdown of fatty acids. presents just like DKA

Question 11

Nonketonic hyperosmolar state?

Answer 11

Severe hyperglycemia, dehydration, altered mental state in a setting of physiological stress may lead to seizure, or death

Question 12

What are the test that should be ordered stat for DKA patient?

Answer 12

Pulse oximetry, oxygen inhalation, IV access, normal Saline, cardiac monitoring, fingers stick glucose

Question 13

What are the test that should be ran after initial testing results arrive?

Answer 13

CBC with differential, calcium, serum Amylase, serum lipase, Abdominal differential. Urine pregnancy test, EKG, discontinue oxygen, ABG vitals follow up. UA, BMP, Serum osmolality, serum Ketones for DKA differential. Regular insulin IV, Phenergan IV; HbA1c, Phosphorus

Question 14

How was the DKA patient diagnosed?

Answer 14

Clinical features, elevated blood glucose, increased anion gap, serum ketones, serum osmolality.

Question 15

Explain BMP of decay patients? Explain the sodium level?

Answer 15

Sodium chloride bicarbonate all low
Potassium maybe high; Pseudohyponatremia secondary to elevated blood sugar. Treatment of hyperglycemia maybe resolve the hyponatremia

Question 16

Where should the DKA patient be admitted?

Answer 16

ICU

Question 17

We should be done for management when the patient DKA is it admitted?

Answer 17

Urine output, BMP Q 2 to 4 hours then Q8 to 12 hours then Q daily, ABG Q 2hrs twice, Potassium chloride IV continuous, vitals,

Question 18

After four hours we should be done to the fluids for DKA patient?

Answer 18

Stop normal saline and give half normal sailing.

Question 19

We should be done about the potassium level and DKA patients?

Answer 19

Monitor potassium deficiency and add IV potassium chloride as needed

Question 20

When should antibiotics be considered for DKA patient? What test should be ran?

Answer 20

CXR, Blood cultures, UA and urine cultures

Question 21

When should feeding DKA patients be done?

Answer 21

Once nausea is decreased start oral fluids

Question 22

When can DKA patient be transferred to the ward/floor?

Answer 22

Once they are stabilized

Question 23

What should be done during discharge for DKA patient?

Answer 23

DC IV insulin convert to NPH insulin subcutaneous and regular insulin subcutaneously it. DC IV fluids convert to diabetic diet/advance diet. Or advanced diet. DC cardiac monitor

Question 24

How was DKA diagnosed/confirmed?

Answer 24

Elevated blood glucose usually above 250mg/dL. Low serum bicarbonate level usually below 15mEq/L. Elevated anion gap, ketonemia; both Amylase and Lipase are often elevated in patients with DKA

Question 25

How is hyperosmolar hyperglycemic diagnosis/confirmed?

Answer 25

Serum glucose levels in excess of 600mg/dL. Serum osmolality greater than 330mOsm/kg. Arterial pH above 7.3. Serum bicarbonate above 20mEq/L. No ketonemia. Severe electrolyte depletion

Question 26

What is the cause of severe electrolyte depletion in the hyperosmolar hyperglycemic state?

Answer 26

Severe fluid and electrolyte depletion due to osmotic diuresis produced by extreme levels of glucose in the serum often greater than 1000

Question 27

How was hydration provided for DKA patients?

Answer 27

One or 2 L of normal Saline is given as bolus.
Followed by 500 mL per hour for the first four hours
followed by 250 mL per hour for the next several hours

Question 28

What is the average fluid deficit in the decompensated diabetic patients?

Answer 28

Could range from 4 to 10 L, usually 5 to 6 L

Question 29

At what point do we know that the decompensated diabetic patient has a sufficient amounts of intravascular volume?

Answer 29

Stable blood pressure and good urine output

Question 30

What fluids should be given to a patient who has stable vital signs after volume resuscitation?

Answer 30

250-500 cc an hour for 3-4hours of half normal Saline

Question 31

How was insulin administered in patients with DKA?

Answer 31

Initial bolus of 0.1 U/kg body weight followed by continuous infusion at 0.1 U/kg per hour
when glucose levels approach to 250 mg/dL
insulin infusion are continued however the composition is changed to include 5-10% dextrose and water

Question 32

Why is dextrose added with insulin in DKA?

Answer 32

To prevent hypoglycemia

Question 33

What happens to the potassium levels in patients with DKA after initial treatment?

Answer 33

Regardless of the serum potassium level at initiation of therapy there is usually a rapid decline and potassium concentration in patients with normal kidney function

Question 34

When is bicarbonate therapy unnecessary?

Answer 34

Blood pH is greater than 7.1

Question 35

What DKA patients should receive potassium replacement?

Answer 35

K of <5.3

Question 36

What happened to phosphate during DKA?

Answer 36

Normally intracellular substance however dragged out of the cell during DKA

Question 37

How are phosphate and potassium similar during DK?

Answer 37

Serum levels can be elevated normal or low however total body supply is depleted