DKA is a serious acute complication of diabetes. Characterised by hyperglycaemia, anion gap metabolic acidosis and ketonaemia. Care must be taken not to reduce plasma osmolality too rapidly.
DKA is a serious acute complication of diabetes. Characterised by hyperglycaemia, anion gap metabolic acidosis and ketonaemia. Care must be taken not to reduce plasma osmolality too rapidly.
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DKA is a serious acute complication of diabetes. Characterised by hyperglycaemia, anion gap metabolic acidosis and ketonaemia. Care must be taken not to reduce plasma osmolality too rapidly.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
Introduction • DKA is a serious acute complication of diabetes. • Characterised by hyperglycaemia, anion gap metabolic acidosis & ketonaemia Pathogenesis Precipitating Factors • Inadequate/non-compliance with insulin therapy • Infection • Acute major illnesses (MI, CVA) • New onset Type 1 diabetes • Drugs affecting carbohydrate metablosim (glucocorticoids, high dose thiazides, sympathomimetic agents (dobutamine, dopamine), 2nd-generation antipsychotic agent • Cocaine use Clinical Presentation • Rapid progression (usually over a few days) • Initially polyuria, polydipsia, nocturia & weight loss • Progress to Kussmaul respirations (compensatory hyperventilation for low arterial pH), fruity (acetone) breath, abdominal pain, vomiting • Hypovolaemia (dehydration, decreased skin turgor, dry axillae and oral mucosa, hypotension) • Drowsiness, lethargy & coma (neurologic disturbances due to plasma hyperosmolality) • Fever is rare even in infection due to peripheral vasoconstriction caused by hypovolaemia Diagnosis • Hyperglycaemia (>14mmol/L) • Anion gap metabolic acidosis (pH<7.3, HCO3<15mmol/L) • Other investigations – Serum potassium: usually high (K+ movement into ECF & insulin deficiency) – Serum sodium: normal or low (usually of no concern) – WCC: raised; may be unrelated to infection (hypercortisolaemia) – Urea & creatinine: raised (dehydration • Ketonaemia/ Ketonuria – 3 ketone bodies produced (beta-hydroxybutyric acid, acetoacetic acid, acetone) Laboratory Findings • Hyperglycaemia • Hyperosmolality • ↑blood urea & creatinine (due to ↓GFR) Fluid Replacement • For the 1st 24 hours, 6-8L may need to be given. Normal saline (0.9%) is initially used • Switch to half saline (0.45%) when Na>145mmol/L. Care must be taken not to reduce plasma osmolality too rapidly (cerebral oedema may occur) • Dextrose saline or 5% dextrose should be used when glucose level<15mmol/L • Blood urea, serum electrolytes and serum creatinine must be concurrently monitored. Potassium Supplementation Complications of Treatment Patient Education • Insulin – compliance, skipped doses – Condition of insulin – cloudy, frosted vial, proper storage – Increased requirements due to illness/stress (infection, pregnancy, pancreatitis, trauma, hyperthyroidism, MI) • Signs & symptoms – Hyperglycaemia – thirst, excess urination, fatigue, blurred vision – Acidosis – fruity breath, deep & difficult breathing – Dehydration – dry mouth, warm dry skin, fatigue – Stomach pain, nausea, vomiting, decreased appetite • Action to be taken – Drink plenty of fluids, continue taking insulin dose – Seek medical attention immediately