Diagnosis/Labs
This is the classic triad of DKA.
What are hyperglycemia, metabolic acidosis, and ketosis?
This hormone is deficient or ineffective in DKA.
What is insulin?
This is the first step in the management of pediatric DKA.
What is fluid resuscitation?
The most feared complication of DKA in children.
What is cerebral edema?
Despite the absence of significant ketosis, this hyperglycemic emergency can mimic DKA and has been described in adolescents with type 2 diabetes.
What is hyperosmolar hyperglycemic state (HHS)?
This is the diagnostic threshold for blood glucose in DKA.
What is >200 mg/dL?
This is the major metabolic consequences of a relative lack of insulin.
lipolysis, ketogenesis, gluconeogenesis, and glycogenolysis
This lab value is the most reliable for assessing resolution of ketoacidosis.
What is the anion gap?
This is a typical sign of cerebral edema on exam.
What is altered mental status?
This electrolyte, often elevated from isotonic saline, can cause a misleading acidosis that is not clinically significant.
What is chloride?
This serum marker helps confirm ketosis
What is beta-hydroxybutyrate?
DKA results in this electrolyte abnormality despite normal or high initial levels.
What is total body potassium depletion?
This is the standard infusion rate of insulin.
What is 0.1u/kg/hr?
The first-line treatment for suspected cerebral edema.
What is hypertonic saline or mannitol?
When the anion gap has closed and the patient is ready to eat, this is the timing of subcutaneous insulin in relation to the IV insulin drip.
What is give the subcutaneous insulin with the meal and continue IV insulin for 30 minutes before stopping?
This lab value is the most reliable for assessing the severity of acidosis.
What is serum pH or bicarbonate?
The main mechanism of dehydration in DKA.
What is osmotic diuresis?
This electrolyte must be added to IV fluids even if serum levels appear normal.
What is potassium?
This bedside maneuver is a simple but essential step in treating cerebral edema.
What is elevating the head of the bed to 30 degrees?
This classic physical exam finding in DKA sounds like the patient is trying to sigh their way out of acidosis.
What is Kussmaul breathing?
An elevated anion gap in DKA is primarily due to this.
What are ketone bodies (acetoacetate and beta-hydroxybutyrate)?
This acid accumulates due to lipolysis and fatty acid metabolism.
What is beta-hydroxybutyric acid?
This should not be routinely administered to patients despite their acidosis
What is bicarbonate?
One reason intubating a DKA patient is risky is because of this physiologic challenge that’s hard to reproduce mechanically.
What is profound hyperventilation?
You should never stop insulin until you see this on your labs—even if the blood sugar is normal.
What is a closed anion gap? (Glucose isn’t the villain here, ketones are.)