"Pharmacology CC: DKA & HHS Marisa E. Desimon"

Question 1

Name the counterregulatory hormones.

Answer 1

Glucagon
Cortisol
Growth hormone
Epinephrine

**Increased glycogenolysis in DKA/HHS

Question 2

What are the 3 I’s w/r/t DKA and HHS?

Answer 2

Infection
Insulin
Infarct

Infection->counter-reg hormone increase-> insulin resistance -> hyperglycemia->dehydration

Question 3

These symptoms describe what disorder?
• Absolute or relative insulin deficiency
• Increase in counter-regulatory hormones – Stress, infection, medications
• Volume depletion (5-12L)

Answer 3

DKA and HHS

Question 4

Name the dx:

• Type 1 DM
• Generally Young
• Abdominal discomfort
• Vomiting
• Kussmaul Respirations • Vascular Shock
• Mental Status Changes

Answer 4

DKA

Question 5

Name the dx:

• Type 2 DM
• Generally Elderly
• Debilitating disease • Volume contraction • Generally without
ketoacidosis
• Mental Status Changes

Answer 5

HHS

Question 6

What is the triad of DKA?

Answer 6

Triad

1. Hyperglycemia
2. Metabolic acidosis
3. Ketone production

Question 7

What is the triad of HHS?

Answer 7

1. Hyperglycemia
2. Hyperosmolality
3. Dehydration

absence of ketoacidosis

Question 8

How is insulin administration transitioned after DKA?

Answer 8

MUST overlap insulin infusion with subcutaneous insulin by 1-2 hours to prevent recurrence of hyperglycemia/ketoacidosis

Question 9

What is the major complication to hypokalemia?

Answer 9

Ventricular arrhythmia

Question 10

When should bicarbonate be given as part of a tx for DKA?

Answer 10

Give in severe acidosis (pH 6.5 or EKG changes), but need to individualize

Question 11

How do you track the resolution of DKA?

Answer 11

Follow anion gap (less than 12), and glucose

– Can follow β-hydroxybutyrate if you choose

Question 12

What are poor prognostic factors in DKA an HHS?

Answer 12

Hypotension, azotemia, deep coma, associated illness are poor prognostic factors

Question 13

How is DKA treated?

Answer 13

• fluids
• insulin
• potassium if needed
• monitor electrolytes and anion gap closely (every 2-4 hours)

Question 14

When treating DKA, the glucose should drop how much?

Answer 14

When treating DKA, the glucose should drop about 50-75mg/dL/hr.

Question 15

Why is the anion gap important in monitoring the resolution of DKA?

Answer 15

Follow anion gap
• Don’t follow glucose as this will resolve prior to resolution of ketones
• Don’t follow ketones unless measuring β-hydroxybutyrate directly.

Question 16

Polyurea and polydipsia are due to what in HHS?

Answer 16

Polyurea and polydipsia are due to hyperglycemia