Endocrine Flashcards
5 precipitating factors for DKA
Infection Intoxication Insulin withdrawal Infarction Other concurrent diseases
Name 4 medication groups that can precipitate DKA
Steroids
Beta blockers
Alpha blockers
Diuretics
what is Kussmaul respiration
Deep hyperventilation
Pathognomonic for DKA
Presenting symptoms of DKA
Acute (within 24h) Polyuria/polydipsia Vomiting Dehydration Altered mental state (if severe)
Initial investigations for DKA?
Capillary blood glucose (and ketones if available)
Dipstick (glucosuria/ketonuria)
ABG
What venous blood tests would you do in DKA?
Glucose
FBC (raised WCC)
U+E’s (Electrolyte monitoring)
Plasma osmolality
How do you measure the anion gap?
Sodium - chloride + bicarb
>13 in DKA
Initial management of DKA
IV access Take bloods Start saline fluids Monitor sats, ECG, HR, BP Catheterisation (monitoring urine output)
Mainstay of DKA management
Fluids (to maintain BP) Insulin infusion (0.1 units/kg/hr)
What insulin dose is used in DKA
Infusion of 0.1 units/kg/hr
This can be increased if blood tests do not show sufficient improvement in electrolytes
What fluid(s) do you use in DKA
Initally, 0.9% saline
As glucose comes down, replace with dextrose to prevent rapid correction or overcorrection
Triad needed to diagnose hypoglycaemia
Low plasma glucose
Symptoms of hypoglycaemia
Resolution of symptoms with correction of glucose
Causes of hypos in diabetics?
Overtreatment with medication
Insufficient intake
Alcohol
Symptoms of hypoglycaemia
Shaking and trembling Sweating Parasthesia of lips and tongue Palpitations Hunger Mental disturbance
What changes to meals is a helpful measure in preventing hypos
avoid simple sugars
More meals, smaller portions
