Emergencies Flashcards
cause of DKA
consistently high blood glucose + severe lack of insulin resulting in low intracellular glucose; body begins to breakdown body tissue for energy –> ketones by product –> ketones build up –> acidosis
most likely times for DKA
- at presentation of diabetes
- when ill
- insulin omission
- puberty
- insulin pumps due to lack of long acting insulin
possible presentations of DKA
- nausea, vomiting
- abdominal pain
- hyperventilation
- dehydration
- LoC
acidosis pH in DKA…
< 7.3
< 7.1 if severe
deep laboured breathing associated with severe metabolic acidosis
kussmaul breathing
who to contact if child < 2 years or pH < 7.1 with DKA
PICU
fluid deficit in
- mild and moderate DKA
- severe DKA
- 5% (ph > 7.1)
- 10% (pH<7.1)
when managing DKA when to give subcut or IV insulin
subcut if:
- not vomiting
- alert
- not dehydrated
why is fluid therapy lower for DKA than standard fluid replacement
risk of cerebral oedema
complications of DKA
- hypokalaemia
- cerebral oedema
- VTE
- prevent future episodes
management if hypokalaemia (< 3)
temporary suspension of IV insulin
monitoring required during insulin and fluid therapy for DKA
- hourly: CBG, ketones, vitals, input +output fluids
- LoC + HR every 30 mins
- ECG
- Potassium + urea
- update family members
T1DM is
an autoimmune condition which develops when there is not enough insulin around to keep blood glucose within normal limits
diagnosis of T1DM
- hyperglycaemia
- polyuria
- polydipsia
- weight loss
- excessive tiredness
Fasting plasma glucose >/= 7
OR
2 hour plasma glucose >/= 11.1
2 types of insulin regimes for T1DM
multiple daily injections of basal-bolus insulin; short acting before meals + 1 daily long acting insulin
continuous subcut insulin infusion (insulin pump therapy) which is a programmable pump and insulin storage device that gives regular continuous amounts of insulin by subcut needle/cannula
