Ketoacidosis Flashcards
What happens in DKA
No insulin - starving cells - fat breakdown into ketones
What ketone level counts for DKA
Blood capillary ketones over 3 mmol / L
or urine ketones 2 +
What glucose levels are seen in DKA
Over 11
What pH is seen in DKA vs HHS
DKA - less than 7.3
HHS - no acidosis
Causes of DKA
Starvation
Illness
Infection
Inadequate insulin
MI
Surgery
Symptoms of DKA
No glucose therefore: reduced GCS
Peeing loads therefore - hypotension, tachycardia, dehydration
Abdo pain
Nausea
Kussmaul’s breathing
Ph less than 7 therefore reduced cardiac contractility
How does the brain respond in DKA
Cerebral dehydration therefore it responds by producing osmoles to draw water back in
What investigations do you want to do
Blood gas - looking for: potassium, bicarbs, U and Es
FBC
CRP
Bone profile
Capillary blood glucose
Blood cultures
Urine microscopy
Pregnancy test
Troponins
Why do you become hypotensive in DKA
Glucosuria actually takes sodium with it, so you end up losing about 6-8 L
Management of DKA
1L 0.9 percent normal saline over 1 hour
2 L over 2 hours
2 L over 4 hours
then every 4 hours?
Add potassium to second bag if potassium is less than 5.5 mmol/L
If BM is less than 14, add 10 percent dextrose on top of the saline, not instead of it
Insulin - 0.1 units per kg/hr
10 units of Actrapid IM immediately
What do you do if the BM is less than 14
Give dextrose
Halve fixed insulin rate to 0,05 units / kg /hr
How long do you continue with the mx until?
Ketones under 0.6
What do you need to monitor?
Glucose every hour
Plasma every 2-4 hours
ABGs
Fluid intake/output
ECG
BP
Pulse
Resp
Mental status
Temp every 8 hours
What is the consequence of DKA?
Thrombotic events due to hyperosmolality
Mesenteric infarction
Cerebral edema - especially in children as they present late
Cerebral oedema management
Mannitol and dex
