DM: DKA Flashcards
Outline the pathophysiology of DKA
Hyperglycemia, ketoacidosis, and ketonuria
Insulin def = decreased glucose uptake = lipolysis increases serum free FA = hepatic ketogenesis from FA as an alternate source of energy (citric acid cycle switched off by high NADH) = accumulation of ketones (acetone, beta-hydroxybutyrate, acetoacetate) = acidosis
Glucosuria leads to osmotic diuresis, dehydration and hyperosmolarity
K loss = shift from the intracellular to the extracellular space in an exchange with H ions that accumulate extracellularly in acidosis, lost in urine
Outline the aetiology of DKA
Underlying infection (40%)
Missed or disrupted insulin treatments (25%)
Newly diagnosed, previously unknown diabetes (15%)
What are the signs and symptoms of DKA?
Abdo pain, tenderness
N+V
Decreased appetite, anorexia
Malaise, weakness, fatigue
Confusion, coma
Infection = fever, cough, chills, chest pain, dyspnoea, arthralgia
Tachycardia
Hypotension
Kussmaul breathing - fruity smell
How would you investigate DKA?
Bloods = glucose, U+Es, amylase, lipase, bicarb
Urine dipstick
Ketones
ABG
Urine, blood cultures
ECG
CXR = pneumonia
CT head = detect cerebral oedema
Assess signs of infection
How would you manage DKA?
Fluid resuscitation - 0.9% saline 1L in 1h, then 2h
Insulin 0.1U/kg/h
Reversal of the acidosis and ketosis
Replenishment of electrolyte and volume losses
Identification the underlying cause
What are the complications of DKA?
MI
DVT
Acute gastric dilation
Respiratory distress
Cerebrovascular accident
What can high levels of serum glucose, triglyceride and ketone bodies cause?
high serum glucose levels may lead to dilutional hyponatremia
high triglyceride levels may lead to factitious low glucose levels
high levels of ketone bodies may lead to factitious elevation of creatinine levels
What is the appropriate clinical environment for a pt with DKA?
HDU
