DKA

Question 1

What is this a presentation of?
Confusion, vomiting, polyuria, polydipsia, weight loss, abdominal pain. Dehydration, Kussmaul breathing, fruity smelling breath, drowsiness, shock, coma.

Answer 1

Diabetic ketoacidosis

Question 2

How is a diabetic ketoacidosis diagnosed?

Answer 2

1. Hyperglycaemia (>11.1mmol/L)
2. Acidosis (pH <7.3 and bicarbonate <15mmol/L)
3. Ketones in urine and/or blood

Question 3

What determines the severity of a diabetic ketoacidosis?

Answer 3

1. Mild - pH <7.3
2. Moderate - pH <7.2
3. Severe - pH <7.1

Question 4

What is the immediate management for a diabetic ketoacidosis?

Answer 4

1. Resuscitate, ABCDE
2. Fluid rehydration with 0.9% NaCl
3. Confirm diagnosis with finger prick glucose and VBG
4. ECG for signs of hyperkalaemia (calcium gluconate)
5. Calculate fluid replacement
6. Start IV insulin after 1-hour of IV fluids (actrapid)
7. Once glucose <14, switch to bag with added dextrose and half insulin infusion rate.
8. When blood ketones <1mmol/L and patient can eat, give SC insulin and stop IV insulin 1 hour after this dose.

Question 5

What is the main complication of a diabetic ketoacidosis, how does it present, and how is it managed?

Answer 5

1. Cerebral oedema
2. Sudden CNS deterioration
3. IV mannitol 1g/kg, half IV fluid maintenance, CT head.