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14 Cards in this Set
- Front
- Back
The diagnosis of DKA reflects the patient has
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Ketosis: Acetone positive >1:2
Acidosis: PH<7.35 HCO3 < 18 Hyperglycemic |
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Precipitating factors of DKA
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Inadequate insulin
Infection Infarction Inebriation Injury Initial diagnosis Iatorgenic (thiazides, steroids, Sympathomimetics) |
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Clinical features of DKA
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Nausea, vomiting, abd pain, polyuria, thirst, sob, altered mental status
dehydration, tachypnea, hypotension, abd tenderness |
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Laboratory findings of DKA
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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.) |
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Treatment of DKA
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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 |
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Complications of DKA
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cerebral edema
hyperchloremic metabolic acidosis non cardiogenic pulmonary edema hypokalemia hypoglycemia |
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Adverse effects of Bicarbonate in the treatment of DKA
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Delayed resolution of ketosis
Cerebral edema hypokalemia |
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HHNK
Hyperosmolar hyperglycemic syndrome elements |
insulin deficiency
renal impairment cognitive impairment |
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Clinical findings in HHNK
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Fever,
dehydration hypotension tachycardia hyperventilation tremors fasciculations mental status change seizure |
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Lab findings in HHNK
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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 |
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Treatment for HHNK
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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 |
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Complications of HHNK
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Hypotension
Cerebral edema thrombosis |
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maximum iv insulin dose rate
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20 U/hr
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what is the 1500 rule
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formula to determine the pts sensitivity factor
ie: 1500/X = sensitivity factor X = number of units pt receives as daily dose. |