DKA Tuesday March 10th

Tuesday we talked about diabetic ketoacidosis. Much more commonly in a type 1 diabetic and due to a lack of insulin. The body cannot turn off breakdown of fatty acids and excessive acetyl coa gets converted to ketones in the liver. The body also cannot take up glucose because insulin is needed for GLUT4 receptors (which are present on cardiac and skeletal muscle, as well as adipose cells).

Crucial points!

1. Look to the anion gap, a normal glucose, a normal pH does NOT rule out DKA. With increasing obesity, a 20 year old obese male could be mistaken for a type one. For every 10 of albumin that is below 40, add 3 to the anion gap.

i.e. If the AG is 12, but albumin is 30, the gap is really 15 (thus elevated!)

2. Patients are often volume deplete, so 2 large bore IVs and start fluids! 

3. Do NOT start insulin until you have confirmed potassium level, start insulin and giving potassium when results are high normal (5.1). Withhold giving insulin if potassium is less than three.

4. Advising patients about sick takes: more frequent blood sugar checks, NEVER stop long acting insulin

Below is a link to guidelines from the Canadian Diabetes Association, they have detailed easy to read power points, a great resource!

http://guidelines.diabetes.ca/fullguidelines/Chapter15