[Endo] Diabetic Ketoacidosis Flashcards
what is diabetic ketoacidosis (DKA)?
diabetic emergency typically seen in T1DM and to a lesser extent, T2DM
what is DKA defined as?
- hyperglycaemia >11 mmol/L
- ketones ≥3 mmol/L (blood) or ≥2+ in urine (serum more accurate)
- acidaemia pH <7.1 or bicarb <15 mmol (caused by ketone bodies)
what is the 1st line ix for DKA?
venous blood gas and serum ketones
what are the initial ix for DKA?
- blood ketones
- capillary blood glucose
- venous blood gas
- FBC, U+E, blood cultures
- MSU (midstream specimen urine)
- ECG
- CXR (if indicated)
- continuous cardiac monitoring
you think a pt has DKA. you perform an A-E assessment. what next?
give 1L 0.9% NaCl over 1 hour (stat if systolic BP <90mmHg)
you gave 1L 0.9% NaCl, what next?
commence Fixed Rate Insulin Infusion (FRII) 0.1 units/kg/hour of Actarapid / Humulin S
until when should you continue FRII for?
until blood ketones <0.6, pH >7.3+ / HCO3 >18
what do you do when glucose <14 mmol/L?
replace with 10% glucose
what is the fluid mx like for DKA over 1-12 hours?
0.9% NaCl (1L) + KCl over 2 h ↓ 0.9% NaCl (1L) + KCl over 2 h ↓ 0.9% NaCl (1L) + KCl over 4 h ↓ 0.9% NaCl (1L) + KCl over 4 h ↓ 0.9% NaCl (1L) + KCl over 6 h
what should be assessed hourly?
blood ketones and CBG
- blood ketones should fall by 0.5 mmol/L/hr
- bicarb should rise by 0.5 mmol/L/hr
- blood glucose should fall by 3.0 mmol/L/hr
if not: increase FRII by 1.0 unit/hr
how often should you check VBG for pH, HCO3 and K+?
at 60 mins
at 2 hours
and then 2 hourly
what should you assess at 12 hours?
cardiovascular status
do you need to replace potassium if K+ >5.5?
no
do you need to replace potassium if K+ 3.5-5.5?
yes + 40mmol to NaCl
what do you do if K+ <3.5?
senior review, may need to go to HDU
