FN: Diabetic Ketoacidosis Flashcards
1
Q
Ketogenesis
A
- Decreased insulin leads to increased stresss hormoes and raise dglucagon
- reduced glucose utilisation and increased fat oxidation
- raised free fatty acids and increased ATP and generation of ketone bodies
2
Q
Dehydration
A
- Reduced insulin and decreased glucose utilisation and increased gluconeogenesis –> severe hyperglycaemia
- osmotic diuresis leading to dehydration
- Also, raised ketones and vomiting
3
Q
Acidosis
A
- Dehydration –> renal perfusion
2. Hyperkalaemia
4
Q
Precipitants
A
- Abdo pain + vomiting
- Gradual drowsiness
- Sighing “kussmaul” hyperventiation
- Dehydration
- Ketotic breath
5
Q
Diagnosis
A
- Acidosis (raised AG): pH 11mM (or known DM)
3. Ketonaemia >3mM (>2+ on dipstix)
6
Q
Investigations
A
- Urine: ketones and glucose, MCS
- Cap glucose and ketones
- VBG: acidosis + raised K
- Bloods: U_E, FBC, glucose, cultures
- CXR: evidence of infection
7
Q
Subtleties
A
- Hyponatraemia is the norm
a. Osmolar compensation for hyperglycaemia
b. raised/normal Na indicates severe dehydration - Avoid rapid decrease in insulin once glucose normalised
a. glucose decreases faster than ketones and insulin is necessary to get rid of them. - Amylase is often raised (up to 10x)
- Excretion of ketones –> loss of potential bicarbonate – hyperchloraemic metabolic acidosis after treatment
8
Q
Complications
A
- Cerebral oedema: excess fluid administration - commonest cause of mrotality
- Aspiration pneumonia
- Hypokalaemia
- Hypophosphataemia –> resp and skeletal muscle weakness
- Thromboembolism
9
Q
Management in HDU
A
Gastric aspiration
Rehydrate
Insulin infusion
Potassium replacement
10
Q
Management
A
- Fluids
- Insulin infusion
- Assessment
- Additional measures
- Monitoring
- Resolution
- Transfer to SC insulin
- Pt. Education
11
Q
Fluids used
A
2 bags
2nd bag of fluids with potassium replacement
12
Q
Insulin infusion
A
Actrarapid 0.u/kg/h IVI (6units if no wt. mas 15u)
13
Q
Assessment
A
Hx + full examination
Investigations: capillary, urine, blood,imaging
14
Q
Additional MEasures
A
- Urinary catheter (aim:0.5ml/kg/hr)
- HGT if vomiting or reduced GCS
- Thromoprophylaxis with LMWH
- Refer to specialist diabetes team
- Find and treat precipitating factors
15
Q
Monitoring
A
- Hrly capillary glucose and ketones
- VBG @ 60min, 2h and then 2hrly
- Plasma electrolytes 4 hrly
