DKA

Today we reviewed a case of ?syncope which turned out to also involve DKA.


We reviewed: What are the problems going on in DKA: (and how to manage)

1.     dehydrationà3-6L deficit: Must restore extravascular and intravascular fluid, increase renal perfusions and clearance of glucose

2.     electrolytes (K!!!!) Total body depletion! (initially may be shifted because of hypo-insulin)

3.     hyperglycemia: insulin  to get rid of ketones and stop lypolisis

4.     acidosis

Treat:

1.     Iv NS à a lot!!!!

2.     Replace K when <5.3 and run in fluid, Hold insulin if until K>3.0;

3.     Insulin drip at 0.1 U/kg; add sugar to your saline if AC<15

4.     Acidosis: don’t give bicarb if >6.9; not helpful (? Increase in intracellular CNS acid)

*** keep a close eye on sugar (q1h), lytes and gas (q2-4h) ****

What can KILL in DKA:

1.     Low K

2.     Too MUCH insulinàhypoglycemia

3.     UNDERLYING cause

(Ischemia, iatrogenic, intoxication, insulin non compliance, initial presentation, intra-abdominal process)

When to consider transitioning to subcut insulin:

·      -->follow AG since takes longer to stop ketogenesis and clear ketone than correct glucose

·      -(Bicarb will trail behind because non-AG acidosis from the NS)

-->patient is EATING

  Here is a review on DKA.