DKA

Question 1

Define DKA

Answer 1

Increased lipolysis and increased gluconeogenesis eventually results in excess ketone levels leading to ketoacidosis.

Question 2

what is the pathophysiology behind DKA

Answer 2

-Due to low insulin, there is unrestrained lipolysis and gluconeogenesis.
-Excess glucose is converted into ketones too if they are not used.

Question 3

What does lipolysis result in?

Answer 3

Lipolysis results in fats broken down into fatty acids which are broken down into ketones.

Question 4

what ph are ketones?

Answer 4

acidic

Question 5

what are key features of DKA

Answer 5

• dehydration
• ketoacidosis
• potassium imbalance.

Question 6

what are the risk factors for DKA?

Answer 6

• Undiagnosed T1DM
• Infection/Illness
• Being under 20 years old
  -Poor Insulin compliance

Question 7

What are the differential diagnosis’ for DKA?

Answer 7

-HHS
- Lactic Acidosis (Identical Presentation, but normal ketones and glucose)
- Starved Ketosi

Question 8

what are complications of DKA

Answer 8

• Coma
• Cerebral oedema
• Thromboembolism
• Aspiration pneumonia
• Death
• Dehydration
• MI

Question 9

What are signs of DKA?

Answer 9

• Fruity “Pear Drop” Breath
• Kussmaul breathing (fast, deep breaths
• Reduced Tissue Turgor

Question 10

What are the symptoms for DKA?

Answer 10

• Polyuria
• Polydipsia
• Hyperglycaemia
• Potassium imbalance
• Weight loss
• Nausea and vomiting
• Reduced consciousness
• Acidosis
• Hypotension
• Dehydration

Question 11

how is DKA diagnosed?

Answer 11

Requires all 3 of:
- Hyperglycaemia (blood glucose over 11mmol/l)
- Ketosis (blood ketones over 3mmol/l)
- Acidosis (pH under 7.3)

Question 12

what is the treatment for DKA?

Answer 12

ABCDE should be followed first.
THEN:
F – Fluids – IV 0.9% Saline
I – Insulin at 0.1 units/kg/hour
G – Glucose – Add glucose IV if <14mmol/l
P – Potassium – Add Potassium to IV fluids
I – Infection – Treat underlying infection
C – Chart fluid balance
K – Ketones – Monitor ketones, pH and Bicarbonate levels

Question 13

What are some complications of the treatment for DKA?

Answer 13

hypoglycaemia, hypokalaemia, cerebral oedema and pulmonary oedema.

Question 14

Compare DKA and HHsS

Answer 14

DKA-
T1DM-
-Patients younger and leaner
-Ketoacidosis
- Develops over hours to a day
-HHS
- T2DM
- No ketoacidosis
- Significantly higher mortality rate
- develops over a longer time
- days to a week