Diabetic Keto Acidosis
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Questions and Answers

What is the potential consequence of delayed treatment of DKA?

  • Death (correct)
  • Hypoinsulinemia
  • Morbidity
  • Hyperglycemia

    • In which type of diabetes is DKA more common?

  • Type 1 diabetes (correct)
  • Type 2 diabetes
  • LADA
  • Gestational diabetes

    • What is the minimum serum bicarbonate level in DKA?

  • 10 mEq/dL
  • 20 mEq/dL
  • 15 mEq/dL (correct)
  • 12 mEq/dL

    • Which of the following is NOT a biochemical characteristic of DKA?

    <p>Blood glucose &lt; 200 mg/dL</p> Signup and view all the answers

    What is the typical pH level in DKA?

    <p>&lt; 7.3</p> Signup and view all the answers

    Which of the following can cause DKA?

    <p>Pancreatic damage</p> Signup and view all the answers

    What is the typical blood glucose level in DKA?

    <p>&gt; 300 mg/dL</p> Signup and view all the answers

    What is the common complication of DKA?

    <p>Dehydration</p> Signup and view all the answers

    What is the primary reason for the patient's hyperglycemia?

    <p>Impaired glucose utilization in cells</p> Signup and view all the answers

    What is the consequence of the renal threshold of glucose being exceeded?

    <p>Glucosuria</p> Signup and view all the answers

    Which of the following is NOT a counter-regulatory hormone effect?

    <p>Insulin secretion</p> Signup and view all the answers

    What is the result of the body using fats as fuel instead of glucose?

    <p>Ketosis</p> Signup and view all the answers

    What is the effect of osmotic diuresis in DKA?

    <p>Dehydration and polydipsia</p> Signup and view all the answers

    Which laboratory result is indicative of DKA?

    <p>Urine glucose (4+) and acetone (2+)</p> Signup and view all the answers

    What is the consequence of insulin deficiency in adipose tissue?

    <p>Increased lipolysis</p> Signup and view all the answers

    What is the primary source of energy for the body in DKA?

    <p>Fats</p> Signup and view all the answers

    What is a potential issue with creatinine assays in diabetic ketoacidosis?

    <p>They may not reflect true renal function due to cross-reactivity with ketone bodies</p> Signup and view all the answers

    Why may a diagnosis of pancreatitis be mistakenly made in a patient with diabetic ketoacidosis?

    <p>Due to the elevation of serum amylase</p> Signup and view all the answers

    How often should blood tests for glucose be performed in a patient with diabetic ketoacidosis?

    <p>Every 1-2 hours until stable, then every 4-6 hours</p> Signup and view all the answers

    What is the primary goal of fluid replacement in diabetic ketoacidosis?

    <p>To correct fluid deficits and dehydration</p> Signup and view all the answers

    What is the recommended approach to correcting electrolyte abnormalities in diabetic ketoacidosis?

    <p>Starting potassium replacement early to prevent depletion</p> Signup and view all the answers

    What is the typical dehydration rate in diabetic ketoacidosis?

    <p>10%</p> Signup and view all the answers

    What is the recommended initial hydrating fluid in diabetic ketoacidosis?

    <p>Isotonic saline</p> Signup and view all the answers

    What is the primary difference between diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome?

    <p>The level of consciousness</p> Signup and view all the answers

    What is the primary cause of DKA in diabetic children?

    <p>Omission of insulin</p> Signup and view all the answers

    Which of the following is NOT a clinical manifestation of DKA?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is the most common precipitating factor for DKA?

    <p>Infection</p> Signup and view all the answers

    What is the primary driver of the initial presentation of DKA in diabetic children?

    <p>Ketoacidosis</p> Signup and view all the answers

    What is the typical respiratory pattern seen in patients with DKA?

    <p>Deep and labored breathing</p> Signup and view all the answers

    Which laboratory test is NOT commonly used to assess DKA?

    <p>Lipid profile</p> Signup and view all the answers

    What is the primary reason for the altered level of consciousness seen in patients with DKA?

    <p>Hyperosmolarity</p> Signup and view all the answers

    What is the most common cause of abdominal pain in patients with DKA?

    <p>Pancreatitis</p> Signup and view all the answers

    What is the primary goal of laboratory assessment in patients with DKA?

    <p>To determine the severity of DKA</p> Signup and view all the answers

    What is the most likely diagnosis for a 22-year-old male presenting with a 3-day history of emesis and lethargy?

    <p>Diabetic ketoacidosis</p> Signup and view all the answers

    What is the primary cause of metabolic acidosis in DKA?

    <p>Excess of ketone bodies</p> Signup and view all the answers

    What is the effect of vomiting on the state of dehydration in DKA?

    <p>It worsens the state of dehydration</p> Signup and view all the answers

    What is the effect of acidosis on potassium levels in DKA?

    <p>It leads to an overall depletion of potassium</p> Signup and view all the answers

    What is the effect of osmotic diuresis on potassium levels in DKA?

    <p>It leads to an overall depletion of potassium</p> Signup and view all the answers

    What is the cause of hyperosmolality in DKA?

    <p>Progressive hyperglycemia</p> Signup and view all the answers

    What is the effect of dehydration on kidney perfusion in DKA?

    <p>It worsens kidney perfusion</p> Signup and view all the answers

    What is the significance of a high WCC in DKA?

    <p>It may be seen in the absence of infections</p> Signup and view all the answers

    What is the significance of an elevated BUN in DKA?

    <p>It may be elevated with prerenal azotemia secondary to dehydration</p> Signup and view all the answers

    Study Notes

    Diabetic Ketoacidosis (DKA)

    • DKA is a serious acute complication of Diabetes Mellitus that carries significant risk of death and/or morbidity, especially with delayed treatment.
    • It can be the presenting complaint in new diabetic patients, especially Type 1 Diabetes, and can also occur in Type 2 Diabetes.

    Biochemical Characteristics

    • DKA exists when:
      • Venous pH < 7.3
      • Serum bicarbonate < 15 mEq/dL
      • Blood glucose > 300 mg/dL
      • Anion gap > 10
      • Presence of ketonemia/ketonuria
    • This is usually accompanied by severe dehydration and electrolyte imbalance.

    Triggering Factors

    • Precipitating factors for DKA include:
      • Omission of insulin
      • Intercurrent illness (> 80%) such as infection, myocardial infarction, cardiovascular accident, and pregnancy
      • Other stressors such as mental stress, depression, and trauma

    Clinical Manifestations

    • Initial presentation of DKA may include:
      • Polyuria
      • Polydipsia
      • Polyphagia
    • More severe cases may include:
      • Abdominal pain or rigidity
      • Altered level of consciousness and coma
    • DKA can also cause Kussmaul respirations, fruity acetone breath, and dehydration.

    Clinical Presentation

    • Due to hyperglycemia:
      • Polyuria
      • Polydipsia
      • Polyphagia
    • Due to ketonemia:
      • Anorexia
      • Nausea
      • Vomiting
    • Due to acidosis:
      • Abdominal pain
      • Kussmaul respirations
    • Due to hyperosmolarity:
      • Altered level of consciousness

    Laboratory Assessment

    • Urine and serum ketones
    • Blood glucose
    • Arterial blood gases
    • Serum urea and creatinine
    • Serum electrolyte
    • Serum osmolality
    • Complete blood count
    • Electrocardiogram
    • Blood and urine culture (when infection is suspected)

    Pathophysiology

    • Hyperglycemia results from:
      • Blockage of intracellular glucose transport
      • Counter-regulatory hormone effects
    • Ketone bodies will cause metabolic acidosis, which is aggravated by lactic acidosis caused by dehydration and poor tissue perfusion.
    • Vomiting and dehydration worsen the state of dehydration.
    • Electrolyte abnormalities are secondary to their loss in urine and trans-membrane alterations following acidosis and osmotic diuresis.

    Treatment

    • Careful replacement of fluid deficits
    • Correction of acidosis and hyperglycemia via insulin administration
    • Correction of electrolyte imbalance
    • Treatment of underlying cause
    • Monitoring for complications of treatment
    • Manage DKA in the ICU or special care room of the pediatric inpatient ward if ICU is not available.

    Hyperglycemic Hyperosmolar Syndrome (HHS)

    • Pathophysiology:
      • Dehydration
      • Acidosis
      • Hyperosmolality
      • Diminished cerebral oxygen utilization
      • Impaired consciousness and comatose state

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