Definition

Lab

Treatment Complications

Pathophysiology

Signs and Symptoms

Etiology

Diagnosis

contents

•Diabetic ketoacidosis is near complete deficency of insulin and elevated levels of stress hormones glucagon

cathecolamine cortisol

growth hormone •acute metabolic complication of diabetic characterized by

Hyperglycemia hyperketonemia metabolic acidosis

Defination

DKA is a life-threatening compDKA is a life-threatening complication   in Pt. with untreated DM

(chronic high blood sugar or hyperglyce mia).

DKA occurs mostly in type 1 DM DKA is less common in type 2 DM, but it may occur in situations of physiologic stress . Pts . with new undiagnosed Type 1 DM  frequently present to hospitals with DKA

Definition

Etiology

Insulin deficiency  c relative or absolute increase in glucagon(Inadequate insulin administration)

Infection   or Inflammation ( pneumonia, UTI, gastroenteritis, sepsis)

Ischemia or Infarction ( cerebral, coronary, mesenteric, peripheral)

Intra-abdominal process (pancreatitis, cholecystitis)

 1 . Hyperglycemia :gluconeogenesis, glycogenolysis ,↓glucose uptake into cell (underutilization)  2. Ketosis : lipolysis, keto genesis , ↓ Peripheral tissu -- e uptake ketone )ketonemia 3 . Hypertriglyceridemia  : ↑free fatty acid  4. Osmotic diuresis  :hyperglycemia -- ) renal loss glucose, Na & K -- )electrolyte imbalance 5 . Volume depletion  : h yperglycemia, glucosuria & -- osmotic diuresis )dehydration

 

Pathophysiology

S igns and S  ymptoms Initial symptoms of DKA

Anorexia, nausea, vomiting, abdominal pain Polyuria, polydipsia

  -- Dehydration ) dry mucous membranes, tac hycardia, hypotension

Alterated mental function-- ) somnolence, stupor,coma

Fever is not a sign of DKA -- )signifies underly ing infection

  Classic signs of DKA

  Kussmaul ‘ s respirations   (deep) to comp ensate for metabolic acidosis

  with acetone odor on Pt. breath 

Signs and Symptoms

 

การตรวจทางห้�องปฏิ�บั�ต�การเบั��องต�น1 . Glucose & ketone in serum & urine 2 . Serum electrolyte, BUN, Cr, Ca, PO4 3 . Blood gas : capillary or arterial blood gas4 . EKG : hypo /hyperkalemia5 . CBC UA 

Lab

Serum glucose ) 300 mg/dl                                      

  3Acidosis : serum HCO <   15 /mEq ml orpp < 725.                                                    severity of ppp                                                              Mild           : HCO3    > 15-18 mq/L  & pH > 7.3                      Moderate  :  HCO3      10-15 mq/L & pH  7.1-7.3 Severe      :   HCO3  <  10mq/L &  pH<7.1                               

Ketone : positive ketone in urine and /pp ppppp

 

Diagnosis

  

Confirm Dx  : ↑ BS, positive serum keton e, metabolic acidosisAdmit Assess

Serum electrolyte : K, Na, Mg, Cl, HCO3, PO4

-   Acid base status : pH, H CO3, Pco2Renal function : creatinine, urine output

Replace fluidAdminister regular insulin / RI   Assess patient

What precipitated the episode Initial appropriate work up

Treatment

Measure capillary glucose every 1-2 hr/  E ’lyte, anion gap e

very 4 hr for first 2 4 hr   - MonitorBP, PR, respiration, mentalstatus, fluidi nt ake/out put ever y 1 4hh  hhhhhhh h Continue above until Pt . stable  hhhhhhhhhh intermediate or long – act i ng i nsul i n as soon as Pt . eating                                     / overlap in insulin infusion & su

bcutaneous injection. 

Treatment

•Hypolycemia •Electrolyte imbalance •Hyperlycemia •Metabolic acidosis •Cerebraledema•Hypoxemia,ARDS•Thrombotic events:CVA,MI

Complication