Pathophysiology
DKA is caused by absolute insulin _________.
Deficiency
Deep and labored breathing in an attempt to reduce CO2 and acid burden.
Kussmaul breathing
Name 3 diagnoses to consider on the DDX
Pancreatitis, gastroenteritis, HHS, starvation ketosis, etc...
Do not use ______ to treat the acidemia in DKA.
Bicarbonate
The most serious complication of DKA management.
Cerebral edema
The body uses this process to source out an alternative fuel source.
Lipolysis
The cause of fruity/sweet smelling breath in DKA.
Acetone or Ketone bodies
Be aware of a mixed picture presentation of DKA and ______.
HHS OR hyperosmolar hyperglycemic syndrome
In the first 60 minutes, the priority is giving the patient a ______.
Fluid bolus (10-20mL/kg NS)
Name 2 other complications of DKA and its management.
AKI, pancreatitis, rhabdomyolysis, acute pancreatitis, extended electrolyte dysfunction, hypoglycemia
The body attempts to produce more glucose via these two processes when in DKA.
Glycogenolysis
Gluconeogenesis
Name two poor predictors of hydration status in DKA, which are otherwise used commonly.
Urine output
Dry mouth/mucous membranes
3 diagnostic criteria for DKA
Hyperglycemia with RBG >/= 11mmol/L
Ketone positive blood and/or urine
Acidosis with pH < 7.3 or bicarb < 15mmol/L
Goal of the DKA protocol is to correct a ____ % fluid deficit over a 36 hour period.
10%
Causes of cerebral edema (2/3).
Too much fluid/fluid given too fast
Not enough insulin
Inadequate monitoring
In DKA, serum K+ remains high however total body stores of K+ are ________.
Depleting
Name 2 of the best predictors of hydration status in DKA.
Prolonged cap refill, abnormal skin turgor
Name 4 causes of high anion gap metabolic acidosis.
Alcoholic MA, ethylene glycol intoxication, lactic acidosis, methanol intoxication, rhabdo, uremia
Do not correct the glucose more than ____ to ____ mmol/L per hour.
3 to 5 mmol/L
Name 4 signs/symptoms associated with cerebral edema.
HA, NV, irritability, lethargy, decrease in GCS, drowsiness, incontinence, bradycardia, hypertensive, decreased RR
In DKA, the body tries to correct the acidemia by driving the _______ exchange transporter.
H+ and K+ exchange transporter.
HHS typically presents with a greater fluid deficit and hyperglycemia. You should suspect HHS when the blood glucose is > ____ mmol/L.
33
Criteria for severe DKA classification
pH < 7.1
Bicarb < 5
What order do you start the bags in?
AND
What is in Bag B?
A (NS + 40mEq/L KCl), then C (insulin 0.5-1.0u/kg), then B (D10NS + 40mEq/L)
The mortality rate associated with DKA is ___ to ___ %.
1 to 5 %