Diabetic ketoacidosis

• Who is DKA mostly seen in?

  Type 1 diabetics
• What are some risk factors for developing DKA?

  Insulin deficiency

  Infection

  New onset diabetes

  Meds
• What causes DKA?

  Insulin deficiency or resistance
• What is a brief pathophys of DKA?

  Uncontrolled lipolysis -> excess free fatty acids -> converted to ketone bodies -> inc ketones and dec pH
• What is the triad that typically occurs in DKA?

  Hyperglycemia

  Ketosis

  Metabolic acidosis
• What are some features patients may present with for DKA?

  Polyuria

  Polydipsia

  Profound weakness

  Kussmaul breathing

  Dehydration

  Acetone odour on breath
• What are some precipitating factors for developing DKA?

  Infection

  MI

  Stroke

  Pancreatitis

  Medication non-compliance
• What are the first-line investigations for DKA?

  Blood glucose: >11.1

  Ketones: >3 mmol/L (in blood) or 2+ on urine dip

  VBG: Metabolic acidosis

  U&Es
• Why may further investigations be done even if DKA is confirmed?

  Identify complications or precipitating factors
• What are some further investigations that can be done despite a DKA diagnosis?

  Hba1c: inc = poor long term glycaemic control

  Infection screen

  Cardiac enzymes

  Abdo imaging
• What is the Joint British Diabetes Societies diagnostic criteria for DKA?

  Glucose: >11 mol/l

  pH: <7.3

  Bicarb: <15 mmol/l

  Ketones: >3 mmol/l
• What is the main principles of management for DKA?

  FLuid replacement

  Insulin

  Correction of electrolyte disturbance

  Long-acting insulin should be continued, short-acting insulin should be stopped
• What is DKA resolution defined as?

  pH >7.3

  Blood ketones <0.6

  Bicarb >15
• What are some complications of DKA?

  Gastric stasis

  Thromboembolism

  AKI

  Arrhythmias (secondary to hyperkalaemia/iatrogenic hypokalaemia)

  Cerebral oedema (rare)