Glucose Disorders Flashcards
DKA Triad
Acidosis
Ketosis
Hyperglycemia
Prognosis worsened by
Age extremes
Coma
Hypotension
Hyperglycemia results from
– increased gluconeogenesis
– accelerated glycogenolysis
– impaired glucose utilization
Two main precipitating factors of HHS
Infxn
DC or decrease insulin therapy
Ketosis results from
Insulin deficiency and increased cortisol, catecholamines, and growth hormone leading to increased fatty acid oxidation by the liver
Bicarb buffer most important b/c…
– More bicarbonate in the ECF than any other
buffer
– Unlimited supply of CO2
– Degree of ECF acidity can be regulated by changing HCO3- and/or pCO2
DKA Clinical Presentation
Rapidly develops, usually over 24 hr period w/N/V and abdominal pain, thirst, and polyuria
PE reveals Physical Exam Kussmaul respirations, Fruity breath, Tachycardia, Dry mucous membranes and Poor skin turgor
HHS Clinical Presentation
HHS typically evolves over several days to weeks w/Polyuria, polydipsia, Vomiting, Weakness and Mental status changes
Avg K+ deficit with DKA vs HHS
DKA - 3 to 5
HHS - 5 to 15
Mild DKA
pH 7.25-7.30
Serum Bicarb 15-18
Mod DKA
pH 7 to 7.24
Serum Bicarb 10-14
Severe DKA
pH less than 7
Serum Bicarb less than 10
DKA vs HHS glucose levels
DKA >250
HHS >600
DKA vs HHS pH levels
DKA below 7.3
HHS >7.3
Serum and Urine Ketones in DKA vs HHS
DKA will have high ketones (dKa)
DKA vs HHS anion gap
DKA >12
HHS is variable
Which has more severe dehydration, DKA or HHS?
HHS > DKA
DKA vs HHS serum osmolality
DKA less than 320
HHS > 320
DKA vs HHS serum bicarb
DKA less than 18
HHS > 18
DKA and HHS initial Tx
Aimed at volume expansion and restoration of renal perfusion
– Initial fluid choice is 0.9% NaCl
– 1-1.5 L over first 1 hour
– Subsequent fluid choice depends on hydration status, urine output and electrolytes
When BG reaches 200 mg/dL (DKA) or 300 mg/dL (HHS), switch fluid to D5W + 0.45% NaCl at 250-500 mL/hr
Fluid replacement should correct estimated deficits within the first 24 hrs
When do you switch to D5W + 0.45% NaCl
When BG reaches 200 for DKA or 300 for HHS
Other Tx in DKA and HHS
- Insulin IV (switch SQ once under control w/1-2 hr overlap)
– Hypokalemia is common in the treatment of DKA
and HHS
– 20-30 mEq K+ should be added to each liter of fluid once serum K+ concentration < 5.2 mEq/L (chloride and phosphate salts preferred)
– Insulin therapy should be delayed in patients with a serum K+ concentration < 3.3 mEq/L to avoid severe hypokalemia
