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Y4R1 - Pediatrics I 👶 > L2: DKA > Flashcards

L2: DKA Flashcards

1
Q

Metabolic Actions of Insulin

A
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2
Q

Metabolic Actions of Insulin

  • CHO
A
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3
Q

Metabolic Actions of Insulin

  • PTN
A
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4
Q

Metabolic Actions of Insulin

  • Lipids
A
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5
Q

Metabolic Actions of Insulin

  • Electrolytes
A
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6
Q

Def of DKA

A

Acute metabolic derangement in IDDM characterized by:

  • Hyperglycemia
  • Acidosis
  • Ketosis
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7
Q

Etiology of DKA

A
  • Insulin deficiency (absolute or relative)
  • Elevation of counter regulatory hormones
  • Concomitant reduction of insulin’s effective action
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8
Q

Etiology of DKA

  • Insulin Deficiency
A
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9
Q

Etiology of DKA

  • Elevation of counter regulatory hormones
A
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10
Q

Etiology of DKA

  • Concomitant reduction of insulin’s effective action
A
  • This overwhelms homeostatic mechanisms and lead to metabolic decompensation despite the patient taking the usual recommended dose of insulin
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11
Q

End Result leading to DKA

A
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12
Q

Pathophysiology of DKA

A
  • Osmotic diuresis and hypovolemia
  • Metabolic acidosis with increased anion gap
  • Hypokalemia
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13
Q

Pathophysiology of DKA

  • Osmotic Diuresis & Hypovolemia
A
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14
Q

Pathophysiology of DKA

  • Metabolic Acidosis with Increased Anion Gap
A
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15
Q

Pathophysiology of DKA

  • Hypokalemia
A
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16
Q

CP of DKA

A
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17
Q

Causes of increased or normal BP in DKA

A
  • Increased plasma catecholamine concentrations
  • Release of ADH in response to hyperosmolality
  • Osmotic pressure from marked hyperglycemia
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18
Q

Dx of DKA

A
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19
Q

Dx of DKA

  • Diabetic
A
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20
Q

Dx of DKA

  • Keto
A
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21
Q

Dx of DKA

  • Acidosis
A
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22
Q

Dx of DKA

  • Relation Between hyperglycemia & Acidosis
A

The degree of hyperglycemia does not correlate with degree of acidosis

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23
Q

Severity of DKA

A
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24
Q

Calculation of Severity of DKA

A
  • Anion Gap
  • Corrected Na
  • Effective Osmolarity
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25
Q

Calculation of Severity of DKA

  • Anion Gap
A
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26
Q

Calculation of Severity of DKA

  • Corrected Na
A
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27
Q

Calculation of Severity of DKA

  • Effective Osmolarity
A
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28
Q

Problems of DKA

A
  • Dehydration: moderate to severe
  • Hyperglycemia
  • Acidosis
  • Electrolyte disturbance
  • Precipitating factors
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29
Q

Managment of DKA

A
  • Confirmation of diagnosis
  • Emergency assessment & management
  • Rehydration
  • Insulin therapy
  • K replacement
  • Treatment of acidosis
  • Treatment of precipitating factors
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30
Q

Managment of DKA

  • Confirmation of DKA
A
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31
Q

Confirmation of DKA

  • Blood Sample
A
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32
Q

Emergency Assessment of DKA

A
  • Blood Glucose
  • BOHB & Urine AAA
  • Weight
  • DHD
  • Consciousness
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33
Q

Emergency Assessment of DKA

  • BOHB & AAA
A
  • blood BOHB
  • urine test strips for acetoacetic acid
34
Q

Emergency Assessment of DKA

  • Glucose
A

Immediately measure blood glucose

35
Q

Emergency Assessment of DKA

  • Weight
A

The current weight should be used for calculations

36
Q

Emergency Assessment of DKA

  • DHD
37
Q

Emergency Assessment of DKA

  • Consciousness
A

Assess level of consciousness (Glasgow coma scale)

38
Q

Indications of immediate treatment of DKA in ICU

39
Q

Emergency Managment of DKA

40
Q

Emergency Managment of DKA

  • Airway
41
Q

Emergency Managment of DKA

  • Breathing
42
Q

Emergency Managment of DKA

  • Circulation
43
Q

Emergency Managment of DKA

  • Drugs & Maneuvers
44
Q

Rehydration in DKA

  • Objectives
A
  • Restore circulating volume
  • Replace sodium and the extracellular and intracellular water deficits
  • Improve glomerular filtration and enhance clearance of glucose and ketones from the blood
45
Q

Rehydration in DKA

  • Deficit amount of DKA
A
  • Moderate DKA: >5-7% Dehydration
  • Severe DKA: 7 - 10% Dehydration
46
Q

Rehydration in DKA

  • Not in shock with good tissue perfusion
A
  • Volume expansion (resuscitation) should begin immediately with 0.9% saline.
  • 10 mL/kg infused over 30 - 60 minutes
47
Q

Rehydration in DKA

  • Not in shock with poor tissue perfussion
A
  • The initial fluid bolus is given more rapidly (e.g., over 15 - 30 minutes)
  • A second fluid bolus may be needed to ensure adequate tissue perfusion.
48
Q

Rehydration in DKA

  • In shock
A
  • Rapidly restore circulatory volume with isotonic saline in 20 mL/kg boluses
  • Infuse as quickly as possible
  • Reassess circulatory status after each bolus.
49
Q

Rehydration in DKA

  • General Fluid Replacement
A

Replace the estimated fluid deficit at an even rate over 24 - 48 hr

50
Q

Another method for calculation of deficit amount in DKA

51
Q

Example of volumes of maintenance + 10% deficit, to be given evenly over 48h

52
Q

Rehydration in DKA

  • Types of Fluids
A
  • IV Fluids
  • Oral Fluids
53
Q

Rehydration in DKA

  • IV Fluids
A
  • Saline
  • Na
  • Glucose
  • K
54
Q

IV Fluids Rehydration in DKA

  • Deficit Replacement (Saline)
A

with a solution that has a tonicity 0.45% to 0.9% saline, with added KCI, potassium phosphate or potassium acetate

55
Q

IV Fluids Rehydration in DKA

  • Sodium
A
  • should rise by 0.5 mmol/L for each 1 mmol/L t in glucose concentration
  • The Na content of the fluid should be 1 if measured serum Na concentration is low & doesn’t rise appropriately as the plasma glucose concentration falls
56
Q

IV Fluids Rehydration in DKA

  • Glucose
57
Q

IV Fluids Rehydration in DKA

  • K
A

20 meq/L fluid taken

58
Q

Oral Rehydration in DKA

A
  • Severe DHD
  • Mild DKA
59
Q

Oral Rehydration in DKA

  • In severe DHD & Acidosis
A

only sips of cold water

60
Q

Oral Rehydration in DKA

  • In mild cases of DKA & no vomiting
A

ORS with the usual volume calculation and subtracted from IV fluids

61
Q
  • Oral fluids as rehydration solution or juice only used after clinical improvement and no vomiting and subtracted from IV fluids (within 24hs of starting therapy)
62
Q

Can be used with the usual volume calculation and subtracted from IV fluids

63
Q

Insulin Therapy in DKA

  • Time
A
  • At least 1 hour after starting fluid replacement therapy and reversal of shock
64
Q

Insulin Therapy in DKA

  • Dose
65
Q

Insulin Therapy in DKA

  • Route
66
Q

Insulin Therapy in DKA

  • Recommended Rate of Blood glucose drop
67
Q

Insulin Therapy in DKA

  • SC Insulin
68
Q

K Replacment in DKA

  • if hypokalemia
A
  • Start K replacement at the time of initial volume expansion and before starting insulin therapy (Insulin causes an intracellular shift of K, which can cause life-threatening hypokalemia)
69
Q

K Replacment in DKA

  • if normokalemia
A
  • Start replacing K after initial volume expansion and
    concurrent with starting insulin therapy.
70
Q

K Replacment in DKA

  • If Hyperkalemic
A

Delay K replacement therapy until urine output is documented.

71
Q

K Replacment in DKA

  • Dose & Duration
A
  • Starting K* concentration in the infusate should be 40 mmol/L then according to serum K*.
  • With initial rapid volume expansion, a concentration of 20 mmol/L should be used.
  • K* replacement should continue throughout IV fluid therapy.
  • The maximum recommended rate of IV K* replacement is usually 0.5 mmol/kg/h.
72
Q

K Replacment in DKA

  • if hypokalemia persists
A

If hypokalemia persists despite a maximum rate of potassium replacement, the rate of insulin infusion can be reduced.

73
Q

Profound hypokalemia (<2.5 mmol/L) in untreated DKA is rare and necessitates: …..

74
Q

TTT of Acidosis in DKA

75
Q

TTT of Acidosis in DKA

  • NaHCO3
76
Q

TTT of Acidosis in DKA

  • Dose
A

Cautiously give 1 - 2 mmol/kg over 60 minutes

77
Q

TTT of Predisposing factors in DKA

A

e.g. treatment of sepsis

78
Q

Prevention of DKA

79
Q

CP (Warning Signs) of Cerebral Edema

79
Q

Common errors in diagnosis & management of DKA

80
Q

CP of Cerebral Edema

  • Cushing Reflex
81
Q

TTT of Cerebral Edema

Y4R1 - Pediatrics I 👶 (49 decks)

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