Endocrinology Notes Flashcards
What are some precipitating factors for DKA?
insulin deficiency infections inflammation-pancreatitis, cholecystitis ischemia or infarction intoxication corticosteroids
Describe how you get a bunch of ketones into your body in DKA.
glucagon, catecholamines, cortisol take over.
lipase–get break down into a bunch of FFA
FFA–>krebs–>energy make ketones.
What are the 3 main lab abnormalities seen in DKA?
glucose>250
HCO316, ph
T/F Ketosis is a feature seen in both DKA and HHS.
False. Only DKA
How can you develop non-anion gap metabolic acidosis in DKA?
with urinary loss of ketones and chloride
Give some other weird lab abnormalities seen in DKA.
pseudohyponatremia (from hyperglycemia)
decreased or increased potassium
leukocytosis
elevated amylase (confusing)
elevated BUN/CR from decreased kidney perfusion
Mg level may be low (peeing out-weird osmotic pressures)
phosphate normal or high (goes down with appropriate treatment)
What is the equation to correct for pseudohyponatremia?
Corrected Na=measured Na + [2.4X (measured glucose-100)/100]
What are the symptoms of DKA?
polyuria with polydipsia dehdyration weight loss fatigue dyspnea N/V abdominal pain polyphagia kussmaul respirations somnolence, stupor, coma
T/F DKA may be proceeded by febrile illness.
T
Fluid treatment for DKA?
NS @1L/hr
4-14 mL/kg/hr for maintenance
once BP stabilized: switch to 1/2 NS + D5W
What type of insulin treatment should a patient with DKA receive?
start right away!
10 U bolus
0.1 U/kg/hr
decrease to 0.05-0.1 U/hr once glucose
How should you deal with potassium replacement in patients with DKA?
replace unless >5.2
20-30 mEq/hr
if less than 3.3–>hold insulin and replace.
Describe bicarb replacement in DKA.
only if ph
Describe phosphate replacement in DKA.
replace if levels fall below 1.0
add 20 Meq to IVF
When should you replace magnesium in patients with DKA?
if levels fall below 1.2
or are symptomatic.
