DKA1 Flashcards
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?
Acute decompensation heart failure; high blood pressure and high respiratory rate
How do patients with CHF exacerbation present?
Months of progressive increasing shortness of breath that has acutely worsened over the last day or so, now experiences SOB at rest
How does the cough present in acute decompensation heart failure?
Mild cough with deep inspiration, pink frothy sputum
What are the vital signs for a patient who has DKA?
Hypotension, tachycardia, tachypnea, rapid and shallow breathing, febrile
What with the chief complaint for a patient who has DKA?
Abdominal pain ass. with vomiting
What are the associated symptoms with DKA?
The drowsiness and weakness LOC confusion, Deep gasping breathing, Along with classic diabetes symptoms such as polydipsia, polyuria etc.
What should be examined DKA patient?
General HENT, neck, heart, lungs, abdomen, extremities
What are the positive physical examination findings for DKA?
Weak peripheral pulses along with diffuse abdominal pain, dry mucus membranes
What are the differential diagnoses for abdominal pain with vomiting?
Abdominal pathology, menstrual symptoms or pregnancy related complications, DKA, nonketotic Hyperosmolar state, alcoholic ketoacidosis, drug intoxication
What is alcoholic ketoacidosis?
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
Nonketonic hyperosmolar state?
Severe hyperglycemia, dehydration, altered mental state in a setting of physiological stress may lead to seizure, or death
What are the test that should be ordered stat for DKA patient?
Pulse oximetry, oxygen inhalation, IV access, normal Saline, cardiac monitoring, fingers stick glucose
What are the test that should be ran after initial testing results arrive?
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
How was the DKA patient diagnosed?
Clinical features, elevated blood glucose, increased anion gap, serum ketones, serum osmolality.
Explain BMP of decay patients? Explain the sodium level?
Sodium chloride bicarbonate all low
Potassium maybe high; Pseudohyponatremia secondary to elevated blood sugar. Treatment of hyperglycemia maybe resolve the hyponatremia
Where should the DKA patient be admitted?
ICU
We should be done for management when the patient DKA is it admitted?
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,
After four hours we should be done to the fluids for DKA patient?
Stop normal saline and give half normal sailing.
We should be done about the potassium level and DKA patients?
Monitor potassium deficiency and add IV potassium chloride as needed
When should antibiotics be considered for DKA patient? What test should be ran?
CXR, Blood cultures, UA and urine cultures
When should feeding DKA patients be done?
Once nausea is decreased start oral fluids
When can DKA patient be transferred to the ward/floor?
Once they are stabilized
What should be done during discharge for DKA patient?
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
How was DKA diagnosed/confirmed?
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
How is hyperosmolar hyperglycemic diagnosis/confirmed?
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
What is the cause of severe electrolyte depletion in the hyperosmolar hyperglycemic state?
Severe fluid and electrolyte depletion due to osmotic diuresis produced by extreme levels of glucose in the serum often greater than 1000
How was hydration provided for DKA patients?
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
What is the average fluid deficit in the decompensated diabetic patients?
Could range from 4 to 10 L, usually 5 to 6 L
At what point do we know that the decompensated diabetic patient has a sufficient amounts of intravascular volume?
Stable blood pressure and good urine output
What fluids should be given to a patient who has stable vital signs after volume resuscitation?
250-500 cc an hour for 3-4hours of half normal Saline
How was insulin administered in patients with DKA?
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
Why is dextrose added with insulin in DKA?
To prevent hypoglycemia
What happens to the potassium levels in patients with DKA after initial treatment?
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
When is bicarbonate therapy unnecessary?
Blood pH is greater than 7.1
What DKA patients should receive potassium replacement?
K of <5.3
What happened to phosphate during DKA?
Normally intracellular substance however dragged out of the cell during DKA
How are phosphate and potassium similar during DK?
Serum levels can be elevated normal or low however total body supply is depleted
