endocrine

Question 1

abdo pain and vomiting 
deterioration 
drowsy and irritable
unwell for 24hrs 
type 1 diabetes

diagnosis

Answer 1

DKA

Question 2

what criteria is needed for DKA

Answer 2

hyperglycaemia >11 (or known diabetic)
ketonaemia >3
acidosis pH<7.3 (or HCO3 <15)

Question 3

causes

Answer 3

pshyiological stress:

• acute infection
• MI
• stroke
• pancreatitis
• trauma

drugs

• corticosteroids
• thiazide diuretics
• sympathomimetics

lifestyle

• alcohol
• poor compliance
• lack of routine

Question 4

management for DKA

Answer 4

ABCDE
IV access, bloods: U&Es 
fluid resus 
rehydration and electrolyte replacement 
monitor ketones
look for and treat underlying cause

Question 5

fluid regime for DKA

Answer 5

0.9% NaCl 1L over first hr
0.9% NaCl + KCl 1L over next two hrs (over 2hrs to stop KCl being given no quicker than 10mmol/hr) - usually 10mmol/hr
“ 1L over next 4 hrs
“ 1L over next 4 hrs
“ 1L over next 6hrs

continue with KCl until K+>5.5

Question 6

fixed rate insulin infusion for DKA

Answer 6

0.1 units/hr/kg
70kg = 7 units/hr equivalent to 7ml/hr

continue patients normal long acting insulin dose

Question 7

potassium replacement for DKA

Answer 7

if K+ >5.5 no replacement needed
if 3.5-5.5 –> 40mmol/L of K+ infusion
if <3.5 senior review as additional K+ needed

Question 8

glucose replacement for DKA

Answer 8

once blood glucose <14 start 125ml/hr 10% glucose (dextrose) along side normal saline
do not slow insulin rate

Question 9

monitoring for DKA

Answer 9

holy blood sugar
hrly capillary ketones (reduce blood ketones by 0.5mmol/L/hr)
K+ and VBG monitoring at 1,2,4, and 6 hrs then 12 hrly if improving

resolution:
pH> 7.3
serum ketones <0.3
patient eating and drinking normally - give short acting insulin with meal and stop IV insulin after 1 hr
if not eating and drinking start sliding scale insulin