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14 Cards in this Set

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The diagnosis of DKA reflects the patient has
Ketosis: Acetone positive >1:2
Acidosis: PH<7.35 HCO3 < 18
Hyperglycemic
Precipitating factors of DKA
Inadequate insulin
Infection
Infarction
Inebriation
Injury
Initial diagnosis
Iatorgenic (thiazides, steroids, Sympathomimetics)
Clinical features of DKA
Nausea, vomiting, abd pain, polyuria, thirst, sob, altered mental status
dehydration, tachypnea, hypotension, abd tenderness
Laboratory findings of DKA
Glucose >250
acidosis ph <7.3 HCO3 <18
Ketosis acetone >1:2
Potassium elevated at DX
BUN cr elevated
Na reduced (1.6 meq for every 100 mg elevation in glucose.)
Treatment of DKA
Mild DKA may use Insulin sc/im
otherwise IV insulin.
1-2 hour overlap when switching from iv to sc.
IF K+ is < 3.3 hold insulin until K+ raises to at least 3.3
Provide calories via IV dextrose when BG starts to fall
If ph <6.9 give HCO3 100 mmol in 400 ml H2O @ 200ml/hr
Only replace phosphate if <1mg/dl
Complications of DKA
cerebral edema
hyperchloremic metabolic acidosis
non cardiogenic pulmonary edema
hypokalemia
hypoglycemia
Adverse effects of Bicarbonate in the treatment of DKA
Delayed resolution of ketosis
Cerebral edema
hypokalemia
HHNK
Hyperosmolar hyperglycemic syndrome elements
insulin deficiency
renal impairment
cognitive impairment
Clinical findings in HHNK
Fever,
dehydration
hypotension
tachycardia
hyperventilation
tremors
fasciculations
mental status change
seizure
Lab findings in HHNK
Glucose >600
Serum acetone normal seldom exceeding 1:2
Osmolality > 350 mOsm/kg
Bicarb >15
ph >7.25
Na 100 -180
K+ 2.2 - 7.8
Treatment for HHNK
Fluid replacement 6-8 l over 24 hours
K+ replacement if voiding
Insulin after fluids and electrolyte replacement
dose 1-5 u/h maintain BG 250 first 24 hours
Complications of HHNK
Hypotension
Cerebral edema
thrombosis
maximum iv insulin dose rate
20 U/hr
what is the 1500 rule
formula to determine the pts sensitivity factor
ie: 1500/X = sensitivity factor
X = number of units pt receives as daily dose.