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32 Cards in this Set
- Front
- Back
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what 3 things characterize DKA?
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hyperglycemia
Ketonemia Metabolic Acidosis |
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what is the primary abnormality (cause) in DKA?
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absolute or relative insulin deficiency
this leads to a rise in counterregulatory hormones leading to 1. Hyperglycemia resulting from decreased glucose utilization and increased hepatic gluconeogenesis 2. Increased lipolysis leading to ketone body formation 3. increased metabolism of protein and reduction in protein synthesis |
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what vital sign change is most frequent in DKA
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tachycardia
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what are Kussmaul respirations
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Increased rate and depth of respirations seen in DKA
due to acidemia leading to direct stimulation of the respiratory center in attempt to compensate |
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if the bedside glucose is >___ fluid resuscitation should be initiated prior to obtaining formal lab results
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300mg/dL
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required labs for a pt in DKA
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glucose
serum electrolytes BUN Cr Ca Mg Phosphate CBC Serum ketones should be ordered as urine dipstick can be falsely negative blood gas is good too Serum K is extremely important |
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What type of K levels do you expect in a pt with DKA
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serum K may be very high on first sampling despite the fact that the pt is severely K depleted
due to acidosis enhancing K release from cells in exchnage for H ions in serum in attempt to normalize pH |
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What do you expect Na lvls to be like in DKA
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Pseudohyponatremia
due to hyperglacemia corrected by adding 1.6mEq of Na per 100mg of glucose >100 |
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how do you find a corrected Na in the presence of hyperglycemia?
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corrected by adding 1.6mEq of Na per 100mg of glucose >100
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what heart study is mandatory for DKA
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ECG to look for MI as precipitant of DKA or for hyperK
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guidlines published by the american diabetic association outline 3 biochemical requirements for the diagnosis for DKA... they are?
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1. Glucose >250
2. Arterial pH<7.35, venous pH<7.30 or bicarb<15 3. Ketonemia or ketonuria |
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3 mainstays of DKA tx?
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Fluid replacement
Insulin Therapy K replacement |
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when should a 5% dextrose fluid solution be used in DKA pts?
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when glucose falls <300mg/dL
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how is insulin initially administered and then how is it maintained in DKA?
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0.1 units/kG IV bolus
followed by continuous infusion of short acting insulin at 0.1 units/kg/hr (max initial dose is 10 units/hr) |
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when should insulin infusion be stopped?
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when serum ketones are cleared and the pts anion gap has normalized (<12-14)
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what are some of the ECG findings of hyperkalemia?
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Peaked T waves
prolonged PR widened QRS |
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at what K lvl should potassium repleation be initiated BEFORE insulin?
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<3.5
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Serum glucose and electrolytes should be checked at what time periods from presentation?
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0,2,4 hrs from presentation
then every 4 hours during insulin infusion and K replacement |
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children with DKA have a higher rate of developing what complication than adults?
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Cerebral edema
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what are 2 rare but life threatening complications of DKA
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Cerebral Edema (tx with mannitol and dexamethasone)
ARDS |
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Ketosis and acidosis are minimal or absent in this problem of elevated blood glucose
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Hyperosmolar hyperglycemic state (HHS)
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HHS is most commonly seen in what type of diabetes?
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Type 2
poorly controlled or undiagosed |
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What is the pathophys behind HHS?
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insulin resistance-->inadequate tissue use of glucose-->hyperglycemia
Hepatic gluconeogenesis and glycogenolysis further elevate serum glucose as glucose goes up, draws water out of intracellular space serum glucose lvl exceeds kidneys capacity to reabsorb it, glucose spills into urine, creating osmotic diuresis |
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HHS is defined by what 2 things
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Serum glucose >400 mg/dL
Calculated plasma osmolality>315mOSM/L in absence of ketosis note: in practice glucose usually>600 and osmolality >>350 |
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which has a larger fluid deficit, HHS or DKA?
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HHS
8-12 L (about double DKA) |
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What electrolyte imbalance is often seen in HHS
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HypoK
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what type of medicine would a pt have to be on to hold them for an extended time for hypoglycemia?
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Oral hypoglycemic agents (i.e sulfonylureas)
octreotide in combo with dextrose has been recommended as first line therapy |
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in elderly diabetics, what aspects of the exam are key for a source of infection/ (3)
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urine
feet perineal area |
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what should be done for any pt who is confused or presetns with a neurologic defict (including coma, siezure, or focal neuro deficit)
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rapid bedside Capillary glucose
(fingerstick) |
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insulin should not be given until what is known for pts with DKA or HHS?
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serum K lvl
note: initial therapeutic intervention is FLUID not insulin |
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always replace K in pt with DKA and HHS UNLESS the initial K levle is ?
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>5.5
or the pt is anuric |
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what are the two main ketoacids produced in DKA?
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acetoacetate
beta-hydroxbutyrate |
