Endocrine

Question 1

DKA ?

Answer 1

Glucose > 11 mmol/ml (or normal in SGLT2 inhibitor)
Ketones > 3 or +++ ketones on urinalysis
pH: < 7.3 HCO3 < 15

in either known OR no history of diabetes!

Question 2

Causes of DKA

Answer 2

• first presentation
• infection
• missed medications
• NBM - vomiting, NBM

Question 3

Symptoms of DKA

Answer 3

No insulin, glucagon not inhibited, serum glucose increase, increase lipolysis, increase ketones

Present
High glucose, osmotic diuresis, excrete lots of glucose in urine and water follows
- polyuria
- polydipsia
- AKI and dehydration,
- risk of electrolyte abnormalities - low K+ - risk of heart problems!

High ketones -> acidosis
- Abdo pain
- Nausea and vomiting
- Kassumaul breathing
- peripheral vasodilation
- cells don’t function in acidosis - confusion, drowsy, low GCS

Hypotensive shock!

Question 4

DKA management

Answer 4

• FRII (0.1 unit/kg)
• Fluids
  NaCL 1 litre over 1 hour as per protocol, per guidelines, 10 kg = 1 litre roughly
• VTE
• long acting insulin prescribe - prevent rebound hyperglycaemia
• monitor
  K+ - may be low, reassess before each bag of fluids, replace as per 10 mmol hr MAX
  Ketones - should fall 0.5 mmol an hour
  Glucose - if low, give dex
• Fluid balance
• Escalation

When resolution, VRII if not eating, or eating (ensure long acting given, prescribe and give short acting @ meal time)

Question 5

Resolution of DKA?

Answer 5

Ketones < 0.6 mmol/ml
pH > 7.3