Med I - Diabetic Ketoacidosis

Front 1

Diabetic ketoacidosis
-due to

Back 1

-severe insulin deficiency

Front 2

Diabetic ketoacidosis
-reason for ketone accumulation

Back 2

-impaired FA metabolism

Front 3

Diabetic ketoacidosis
-needs what for resolution

Back 3

-insulin

Front 4

Diabetic ketoacidosis
-why is there a low pH

Back 4

-ketones lower pH
-ketones = metabolic acids

Front 5

Diabetic Ketoacidosis
-can be precipitated by

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-inadequate insulin therapy
-physiologic stress
-drugs affecting insulin production/action
-bacterial infection
-decreased fluid intake

Front 6

Diabetic ketoacidosis
-presenting signs for recognition in the ER

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-inconsistent presentation from mild illness to coma
-PU/PD
-Lethargy & weakness
-inappetance
-vomiting
-neurologic abnormalities

-emaciation
-acetone odor
-recent illness/drug therapy

Front 7

Diabetic ketoacidosis
-major drug therapy that can predispose for disease

Back 7

-steroid

Front 8

Diabetic Ketoacidosis
-physical exam

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-dehydration
-hypo-/hyperthermia
-signs of hypovolemic shock
-neurologic abnormalities
-evidence of diabetes
-signs of concurrent disease (abdominal pain, jaundice)

Front 9

Signs of hypovolemia and shock

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-tachycardia
-poor pulse strength
-poor perfusion

Front 10

ABCs of emergency room signs

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-airways
-breathing
-circulation

Front 11

Diabetic ketoacidosis
-Lab findings

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-hyperglycemia/glucosuria
-hyperketonemia/ketonuria
-azotemia
-electrolyte abnormalities
-metabolic acidosis
-abnormalities from concurrent illness

Front 12

Diabetic ketoacidosis
-reason for metabolic acidosis

Back 12

-dec. in blood pH and in bicarbonate concentration due to ketone production

Front 13

Diabetic ketoacidosis
-electrolyte abnormalities

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-hyponatremia
-hypochloremia
-hypokalemia

Develop after insulin therapy:
-hypophosphatemia
-hypomagnesemia

Front 14

Diabetic ketoacidosis
-reason for elevated anion gap

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=production of ketoacid anions

Front 15

Diabetic ketoacidosis
-reason for hyperosmolarity

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-markedly elevated serum glucose increases the effective serum osmolarity

Front 16

Diabetic ketoacidosis
-reason for pre-renal azotemia

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-dehydration
-concurrent renal insufficiency

Front 17

Diabetic ketoacidosis
-goals of treatment

Back 17

-volume replacement
-restore euglycemia
-correct metabolic imbalances
-systemic support

Front 18

Diabetic ketoacidosis
-dehydration due to

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-osmotic diuresis (Na & glucose)
-protracted vomiting and diarrhea
-decreased fluid intake (weakness, lethargy, anorexia)

Front 19

Diabetic ketoacidosis
-dehydration treatment preferred fluids

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-Intravenous crystalloids (0.9% NaCl)

Front 20

Diabetic ketoacidosis
-rate of fluid administration for treatment of dehydration

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Hypovolemic shock
-shock fluid dose to restore BP

Dehydration
-replace deficit
-maintenance
-replace loss

Replace the deficit over 6-12 hrs

Front 21

Shock fluid dose for dogs

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-90 mL/kg/hr

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Shock fluid dose for cats

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-50 ml/kg/hr

Front 23

Diabetic ketoacidosis
-effect of rehydration on electrolyte disturbances

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-replenished stores of sodium and potassium with use of isotonic saline and supplemented potassium
-possible decrease in serum magnesium and phosphate

Front 24

Diabetic ketoacidosis
-effect of rehydration on acid/base status

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-restored tissue perfusion (enhanced oxygen delivery to tissues --> dec. lactate)
-enhanced urine production (increased excretion)

Front 25

Diabetic ketoacidosis
-effect of rehydration on hyperosmolarity and hyperglycemia

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-dec. serum glucose via dilution
-promoted renal loss of glucose via urination

Front 26

Diabetic ketoacidosis
-how to restore euglycemia

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Use short acting insulin (regular)
-administer IV or IM
-CRI or intermittent therapy

Front 27

Diabetic ketoacidosis
-for how long should insulin be used

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-until ketoacidosis is resolved
-supplement with glucose if hypoglycemia occurs

Front 28

Diabetic ketoacidosis
-why should insulin not be administered SQ

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-dehydration decreases absorption

Front 29

Diabetic ketoacidosis
-2 major goals of insulin therapy

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-control hyperglycemia
-stop ketogenesis

Front 30

Diabetic ketoacidosis
-target glucose level to reach with treatment

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- <250 mg/dl in 12 hrs

Front 31

Diabetic ketoacidosis
-why should insulin therapy wait until vascular volume is restored in some cases

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-insulin causes fluid and electrolyte movement into cells which can cause vascular collapse
-volume expansion will cause a dec. in serum glucose
-inc. urine production will enhance renal glucose loss

Front 32

Diabetic ketoacidosis
-treatment for metabolic imbalances

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Sodium
-add Na containing fluids

Potassium
-add KCl to crystalloid

Phosphorus
-phosphorus supplementation

Magnesium
-Magnesium chloride/magnesium sulfate supplementation

Front 33

Most common electrolyte disturbance associated with diabetic ketoacidosis
-why?

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-hypokalemia

-body stores depleted
-insulin drive potassium into cells

Front 34

Diabetic ketoacidosis
-when is phosphorus supplementation indicated

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-<2.0 mg/dl

Front 35

Diabetic ketoacidosis
-what occurs if phosphorus levels get below 1.0 mg/dl

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-weakness
-hemolysis

-possibly due to phosphorus needed for ATP, and RBC cell walls break down

Front 36

Diabetic ketoacidosis
-glucose supplementation administration if needed

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-2.5-5% glucose CRI

-usually can just stop insulin for a few mins until glucose rises

Front 37

Diabetic ketoacidosis
-when is treatment of acidosis indicated
-what is administered

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-if severe academia is present after volume replacement

-bicarbonate

Front 38

Diabetes mellitus
-common concurrent disorders

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-pancreatitis
-bacterial infection
-endocrinopathy

Front 39

Diabetic ketoacidosis
-treatment contraindications

Back 39

-steroids
-oral hypoglycemic drugs
-depot insulin prep (slow release and prolonged action)