[Exam 4] Show me for DKA / HHS

Question 1

DKA: What is this?

Answer 1

Occurs in Type 1 Diabetics

Question 2

DKA: What are some causes of this?

Answer 2

Trying to ration / missed insulin

Illness/Infection

Undiagnosed Diabetic

Question 3

DKA: What is going on to insulin?

Answer 3

Decreased Insulin

Question 4

DKA: What changes occur in the body because of this?

Answer 4

Elevated blood sugar levels (300-800)

Cells breakdown fatty acids -> leading to acidosis

Question 5

DKA: When glucose levels get high, what do kidneys do?

Answer 5

Try to filter out glucose, causing increased urination and osmotic diuresis

Question 6

DKA: If urine was tested it would be positive for what

Answer 6

Glucose

Question 7

DKA: Whaht signs may a person show with this?

Answer 7

Polyuria, Polydipsia

Question 8

DKA: With kidneys dumping all the fluid, this can lead to what changes in the body?

Answer 8

Increased creatinine and BUN

Potassium may flucate as well.

Question 9

DKA: What happens when cells start breaking down fatty acids?

Answer 9

Ketones develop through ketogenesis leading to acetone being formed

Question 10

DKA: What does acetone do?

Answer 10

This formed the fruity breath that is a hallmark sign of these patients.

Question 11

DKA: How will the ABGs be for this patient?

Answer 11

Will be acidotic.

pH < 7.35 and HCO3 < 22.

Question 12

DKA: What happens to hydrogen ions?

Answer 12

Will go into cell, while kicking potassium out of the cells. This is what causes hyperkalemia in blood.

Question 13

HHS: What type of diabetic has this

Answer 13

Type 2

Question 14

HHS: What usually initated this?

Answer 14

When they are sick, causing an increase in insulin demand and then causing glucose levels to increase

Question 15

HHS: How does this progress

Answer 15

Over a couple of days . DKA can be sudden

Question 16

HHS: What happens to insulin and glucose levels?

Answer 16

Decreased insulin and increased blood glucose levels (600 - 1200)

Question 17

HHS: What happens to fluid in body?

Answer 17

Osmotic diuresis occurs, causing all of the fluid to be expelled.

Will have dehydration

Question 18

HHS: What changes in labs will kidneys cause?

Answer 18

Increase in creatinine and BUN

Question 19

HHS: What doesn’t happen here that happens in DKA?

Answer 19

The patient does not go into acidosis. Because there is still insulin in the body and glucose is binding to these cells. Their channels are still being opened allowing body to get energy

No ketogensis because of this.

Question 20

Management of DKA/HHS: What will normally be started first?

Answer 20

Fluids. Such as 1L of NS over a couple of hours and then 1/2 NS until the blood sugar reaches 300.

Question 21

Management of DKA/HHS: What happens once blood sugar reaches 300?

Answer 21

It will get swtiched to D5W because you do not want ot bottom out glucose levels

Question 22

Management of DKA/HHS: What treatment occurs after fluids?

Answer 22

Insulin drip.

Question 23

Management of DKA/HHS: Why is an insulin drip used??

Answer 23

Allows m ore insulin to be available to bring glucose levels down

Question 24

Management of DKA/HHS: What role does insulin specificaly have with DKA?

Answer 24

In DKA, it will correct the acidosis because glucose is being pushed into cells and body does not need to rely on fatty acids for energy.

Question 25

Management of DKA/HHS: What is done once acidosis is corected?

Answer 25

We have to replace potassium because it is no longer being pushed out of the blood

Question 26

Management of DKA/HHS: DKA should be associated with what

Answer 26

Type 1 DM, in metabolic acidosis

Question 27

Management of DKA/HHS: Big signs of DKA?

Answer 27

Polyuria , Polydipsia, Dehydrated, Fatigued, Hypotension , Fruity Breath (Ketones)

Kussmal Respiration (because lungs are trying to blow off excess acid)

Question 28

Management of DKA/HHS: How is DKA treated?

Answer 28

With fluids, insulin, and replacing electrolytes

Question 29

Management of DKA/HHS: HHS should be associated with what?

Answer 29

DM2 precipated by some sort of illness with a slow illness

Question 30

Management of DKA/HHS: Big signs of HHS?

Answer 30

Dehydrated so decreased blood pressure. Blood sugar 600-1200. AMS.

Question 31

Management of DKA/HHS: Big management for HHS?

Answer 31

Fluids, electrolytes, and insulin.