Jaber - DKA and HHS

Question 1

All of the following are signs of DKA except:
A. Hypotension
B. Dehydration
C. Bradycardia
D. Weight loss
E. Impaired consciousness and/or coma

Answer 1

C. Bradycardia (should be tachycardia)

Question 2

In DKA, serum ketones will be _____.
A. Positive
B. Negative

Answer 2

A. Positive

Question 3

In DKA, urine ketones will be _____.
A. Positive
B. Negative

Answer 3

A. Positive

Question 4

In DKA, the serum glucose will be > _____.

Answer 4

250

Question 5

In the treatment of DKA, you give IV fluids and regular insulin. At what rate is the insulin given?

Answer 5

• 0.14 units/kg/hr as continuous infusion.
• If serum glucose doesn’t fall by 10% in first hour, give 0.14 unit/kg bolus, then continue previous infusion.
• when serum glucose reaches 200 mg/dL, reduce insulin infusion to 0.02-0.05 units/kg/hour or give rapid acting insulin at 0.1 units/kg SQ every 2 hours.

Question 6

In the treatment of DKA, you give IV fluids and regular insulin. At what rate are fluids given?

Answer 6

Normal saline at 15-20 mL/kg/hour or 1-1.5 L/hour for first hour, then subsequent fluid replacement depends on patient specific factors.

Question 7

For mild DKA, the anion gap will be > ____, while for moderate and severe DKA, the anion gap will be > ___.

Answer 7

Mild = >10

Moderate - severe = >12

Question 8

What is the equation to calculate anion gap?

Answer 8

Anion gap = Na - (Cl + HCO3)

Question 9

What is the equation for corrected serum Na?

Answer 9

Corrected Serum Na = Na + (1.6 (glucose - 100)/100)

Question 10

In DKA, arterial pH will be less than or equal to ____.

Answer 10

7.3

Question 11

When the pH is < ____, 100 mmol of bicarbonate must be given in 400 ml of water + 20 mEq KCl, infused for 2 hours and repeated every 2 hours until pH is greater than or equal to ____. Monitor K every __ hours.

Answer 11

6.9
7.0
Every 2 hours

Question 12

In DKA, if potassium is < ____, hold insulin and give 20-30 mEq/hour of potassium until it is above that number.

Answer 12

3.3

Question 13

In DKA, if potassium levels are between 3.3 and 5.2, what is the protocol?

Answer 13

Give 20-30 mEq K in each liter of IV fluids to keep serum potassium between 4-5 mEq/L.

Question 14

In DKA, if K levels are > 5.2, what is the protocol?

Answer 14

Don’t give K, but check serum K levels every 2 hours.

Question 15

In DKA, serum glucose should be kept between _____ and _____ until resolution of DKA.

Answer 15

150-200

Question 16

Hyperosmolar hyperglycemic state (HHS) occurs in this patient population.

Answer 16

Type 2 diabetics and elderly patients with type 1 diabetes.

Question 17

True or False: mortality rate is higher for HHS than DKA.

Answer 17

True

Question 18

True or False: the management of DKA and HHS are similar.

Answer 18

True

Question 19

DKA is more common in type ___ diabetics.

Answer 19

Type 1

Question 20

True or False: the hyperglycemia seen with DKA is more severe than that seen with HHS.

Answer 20

False: hyperglycemia is usually more severe with HHS than DKA.

Question 21

True or False: the Knesset of hyperglycemia is quicker in DKA than HHS.

Answer 21

True

Question 22

Positive ketones in serum and urine are seen in:
A. DKA
B. HHS
C. Both
D. None of the above

Answer 22

A. DKA

Question 23

True or False: Common symptoms of DKA include nausea, vomiting, and abdominal pain.

Answer 23

True

Question 24

\_\_\_\_\_\_ is the most common cause of death in children and adolescents with type 1 diabetes.
A. Heart disease
B. DKA
C. HHS
D. None of the above

Answer 24

B. DKA

Question 25

What is the equation for effective serum osmolality?

Answer 25

Effective serum osmolality = 2(Na) + (glucose/18)

Question 26

In DKA, you have a _____ insulin deficiency and an increase in counterregulatory hormones.
A. Absolute
B. Relative

Answer 26

A. Absolute

Question 27

Patients with HHS have \_\_\_\_ insulin deficiency, while patients with DKA have \_\_\_\_ insulin deficiency.
A. Absolute, absolute
B. Absolute, relative
C. Relative, absolute
D. Relative, relative

Answer 27

C. Relative, absolute

Question 28

True or False: the most common precipitating factors for DKA and HHS are infection and inadequate insulin production.

Answer 28

True

Question 29

What is the criteria for transitioning patients from IV insulin to SQ in DKA?

Answer 29

1. Blood glucose less than 200
2. pH > 7.2
3. Anion gap less than or equal to 12
4. Bicarbonate > 15

Must meet blood glucose requirement + 2/3 of the others