Glucose Disorders

Question 0

DKA Triad

Answer 0

Acidosis
Ketosis
Hyperglycemia

Question 1

Prognosis worsened by

Answer 1

Age extremes
Coma
Hypotension

Question 3

Hyperglycemia results from

Answer 3

– increased gluconeogenesis
– accelerated glycogenolysis
– impaired glucose utilization

Question 3

Two main precipitating factors of HHS

Answer 3

Infxn

DC or decrease insulin therapy

Question 4

Ketosis results from

Answer 4

Insulin deficiency and increased cortisol, catecholamines, and growth hormone leading to increased fatty acid oxidation by the liver

Question 6

Bicarb buffer most important b/c…

Answer 6

– 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

Question 7

DKA Clinical Presentation

Answer 7

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

Question 8

HHS Clinical Presentation

Answer 8

HHS typically evolves over several days to weeks w/Polyuria, polydipsia, Vomiting, Weakness and Mental status changes

Question 9

Avg K+ deficit with DKA vs HHS

Answer 9

DKA - 3 to 5

HHS - 5 to 15

Question 10

Mild DKA

Answer 10

pH 7.25-7.30

Serum Bicarb 15-18

Question 11

Mod DKA

Answer 11

pH 7 to 7.24

Serum Bicarb 10-14

Question 12

Severe DKA

Answer 12

pH less than 7

Serum Bicarb less than 10

Question 13

DKA vs HHS glucose levels

Answer 13

DKA >250

HHS >600

Question 14

DKA vs HHS pH levels

Answer 14

DKA below 7.3

HHS >7.3

Question 15

Serum and Urine Ketones in DKA vs HHS

Answer 15

DKA will have high ketones (dKa)

Question 16

DKA vs HHS anion gap

Answer 16

DKA >12

HHS is variable

Question 17

Which has more severe dehydration, DKA or HHS?

Answer 17

HHS > DKA

Question 18

DKA vs HHS serum osmolality

Answer 18

DKA less than 320

HHS > 320

Question 19

DKA vs HHS serum bicarb

Answer 19

DKA less than 18

HHS > 18

Question 20

DKA and HHS initial Tx

Answer 20

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

Question 21

When do you switch to D5W + 0.45% NaCl

Answer 21

When BG reaches 200 for DKA or 300 for HHS

Question 22

Other Tx in DKA and HHS

Answer 22

• 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