DM- DKA

Question 1

What is DKA?

Answer 1

• Low insulin- ketogenesis
• Ketone acids produced
• Metabolic acidosis, dehydration and potassium imbalance

Question 2

How does ketoacidosis work?

Answer 2

1- Ketogenesis
2- Hyperglycaemia and high ketones
3- Kidneys make bicarbonate initially time buffer
4- Eventually fails and pH drops

Question 3

How does dehydration occur in DKA?

Answer 3

1- Glucose filtered into the urine

2- Water drawn out into the urine (osmotic diuresis)

Question 4

What potassium imbalance is present in DKA?

Answer 4

Hyperkalaemia or normokalaemia, but total body potassium is low as no potassium is stored in cells at low pH

After treatment, hypokalaemia can occur

Question 5

How does DKA present?

Answer 5

• Polydipsia
• Polyuria
• N&V
• Acetone smell on the breath
• Altered consciousness
• ## Hypotension due to dehydration

Question 6

How is DKA diagnosed?

Answer 6

• Hyperglycaemia (11+)
• Ketosis (3+mmol/L)
• Acidosis

Question 7

How is DKA treated?

Answer 7

FIG-PICK

Fluids (resus, then add K+)
Insulin (actrapid 0.1U/kg/hr)
Glucose (monitor and dextrose infusion)
Potassium (monitor)
Infection (treat)
Chart the fluid balance
Ketones (monitor)

Question 8

What must you do prior to stopping the insulin and fluids?

Answer 8

Restart the patient’s normal insulin regime