Diabetic Ketoacidosis (DKA) Quiz

What is the approximate mortality rate associated with a single episode of DKA?

What is the primary cause of death in patients with DKA?

Which type of diabetes is DKA most commonly associated with?

What is the minimum blood glucose level required for diagnosis of DKA?

What is the primary difference between DKA and HHS in terms of pathogenesis?

What is the common finding in patients with HHS?

What is the estimated fluid loss in a person weighing 100 kg with HHS?

What is the mortality rate associated with HHS?

Why do people with HHS not develop significant ketoacidosis?

What is a common precipitating factor for HHS?

What is a poor prognostic sign for HHS?

What is a key goal of managing HHS?

Why should fluid replacement be less aggressive in HHS?

What is a concern in older patients with HHS?

How should the rate of glucose lowering be guided in HHS?

Why is a slower approach to correction of electrolyte and metabolic abnormalities preferred in HHS?

Acute metabolic complication of diabetes resulting from absolute insulin deficiency, and a medical emergency with important complications
Mortality rates have fallen in the UK, but a single episode is associated with a 5% risk of death, rising to 25% in recurrent cases
Most commonly occurs in people with type 1 diabetes, but can also occur in type 2 diabetes, particularly in those with significant β-cell dysfunction

Hyperglycaemia (blood glucose >11.1 mmol/L or 200 mg/dL)
Hyperketonemia (≥3.0 mmol/L on fingerprick testing) or ketonuria (more than 2+ on urine dipstick testing)
Metabolic acidosis (venous bicarbonate <15 mmol/L or pH <7.3)

Associated with a higher mortality rate (up to 20%) due to age and frailty of the population
Pathogenesis is incompletely understood
Caused by an osmotic diuresis, leading to dehydration and hypernatraemia
Fluid loss can be substantial (10-22 L in a person weighing 100 kg)
Reason for lack of significant ketoacidosis is unclear, possibly due to insulin levels sufficient to prevent lipolysis and ketogenesis

Common precipitating factors: infection, acute illness, drug therapy, and postoperative hospitalization
Poor prognostic signs: hypothermia, hypotension, serum osmolality >360 mOsmol/kg, and multiple comorbidities

Aims: normalize osmolality and blood glucose, replace fluid and electrolyte losses, and prevent complications
Slower approach to correction of metabolic abnormalities recommended, avoiding rapid shifts in osmolality
Co-morbidities must be taken into account, such as cardiac failure and delirium