Endocrine - DKA

Question 0

Most common cause of death in DKA?

Answer 0

Cardiovascular collapse from acidosis, hypovolemia, and electrolyte deficiencies

Question 1

Kussmaul Respirations?

Answer 1

Deep, rapid breathing attempts to compensate for metabolic acidosis

Question 2

Most common precipitating events?

Answer 2

Pneumonia, UTI, MI, Trauma

Question 3

Symptoms related to hypoglycemia and osmotic diuresis?

Answer 3

Polyurea, polydipsia, weight loss, visual blurring, decreased mental status

Question 4

Symptoms related to acidosis?

Answer 4

Nausea, vomiting, abdominal pain, fatigue, shortness of breath

Question 5

Usual labs in DKA?

Answer 5

Hyperglycemia >250
Acidosis 15
Ketosis

Question 6

Manage of DKA?

Answer 6

1 fluid replacement
2 hypoglycemia correction
3 replete electrolytes
4 Clear ketones
5 Treat precipitating cause

Question 7

Managing DKA: Fluid resuscitation?

Answer 7

1-2 L of normal saline within the first hour
Then correct total body water deficit at the rate of 250-500 mL/hour

More gentle hydration in patients with CHF

Question 8

Managing DKA: Insulin

Answer 8

1. IV bolus of 0.1 units per kilogram
2. Continuous infusion of 0.1 units per kilogram per hour
3. Slow rate of infusion to 0.05 and add 5DW when blood glucose becomes <300

Question 9

How to judge resolution of ketoacidosis?

Answer 9

Anion gap closes and bicarb >18

Question 10

Laboratory tests for ketones measure?

Answer 10

Acetoacetate and acetone but NOT beta hydroxybutyrate

Question 11

Why shouldn’t you measure serial serum ketone levels?

Answer 11

Insulin converts beta-hydroxybutyrate to acetoacetate, which actually increases ketones

Question 12

Indications for bicarbonate therapy? Problems with bicarbonate therapy?

Answer 12

PH <7, cardiac instability, severe hyperkalemia

Worsening hypokalemia, paradoxical CNS acidosis, delay in ketone clearance

Question 13

Managing DKA: Postassium

Answer 13

Add potassium when serum concentration <5

Once adequate urine output is established at 20 to 40 mEq potassium to each liter of fluid

Goal: maintain potassium between 4 to 5 mEq

Question 14

Managing DKA: Phosphate

Answer 14

The place if serum phosphate <1 mg/dL with hypoxia, anemia, or cardiorespiratory compromise

Question 15

Rare but serious complications to DKA?

Answer 15

Cerebral edema, ARDS, thromboembolism, acute gastric dilatation

Question 16

Symptoms of hyperosmolar nonketotic diabetic coma?

Answer 16

Glucose >1000
Serum osmolarity >320
Confusion, seizures, or coma

Question 17

HONK: treatment?

Answer 17

1 Volume resuscitation

2 insulin to reverse hyperglycemia (but lesser doses than DKA)

Question 18

Alcoholic ketoacidosis: Typical patient? Mechanism? Signs and symptoms? Tx?

Answer 18

Develops in alcoholics who are malnourished and have depleted glycogen stores

Decreased NADH, inhibiting gluconeogenesis

Anion gap metabolic acidosis due to ketoacidosis and lactic acidosis

Similar symptoms of DKA, But only slightly elevated glucose

Volume and glucose solution

Question 25

Causes of Ketoacidosis?

Answer 25

DKA
Starvation
Alcoholism

Question 26

Most accurate measure of the severity of DKA?

Answer 26

Low bicarb