Snapshot A 12 year old boy, previously healthy, is admitted to the hospital after 2 days of polyuria, polyphagia, nausea, vomiting and abdominal pain. Vital signs are: Temp 37C, BP 103/63 mmHg, HR 112, RR 30. Physical exam shows a lethargic boy. Labs are notable for WBC 16,000, Glucose 534, K 5.9, pH 7.13, PCO2 is 20 mmHg, PO2 is 90 mmHg. Introduction Complication of type I diabetes result of ↓ insulin, ↑ glucagon, growth hormone, catecholamine Precipitated by infections MI drugs (steroids, thiazide diuretics) noncompliance pancreatitis undiagnosed DM Presentation Symptoms abdominal pain vomiting Physical exam Kussmaul respiration increased tidal volume and rate as a result of metabolic acidosis fruity, acetone odor severe hypovolemia coma Evaluation Serology blood glucose levels > 250 mg/dL due to ↑ gluconeogenesis and glycogenolysis tissues unable to use the high glucose as it is unable to enter cells arterial pH < 7.3 ↑ anion gap due to ketoacidosis, lactic acidosis ↓ HCO3- consumed in an attempt to buffer the increased acid hyponatremia dilutional hyponatremia glucose acts as an osmotic agent and draws water from ICF to ECF hyperkalemia acidosis results in ICF/ECF exchange of H+ for K+ depletion of total body potassium due to cellular shift and losses through urine moderate ketonuria and ketonemia due to ↑ lipolysis β-hydroxybutyrate > acetoacetate β-hydroxybutyrate not detected with normal ketone body tests hypertriglyceridemia due to ↓ in capillary lipoprotein lipase activity activated by insulin leukocytosis due to stress-induced cortisol release H2PO4- is increased in urine, as it is titratable acid used to buffer the excess H+ that is being excreted Treatment Fluids Insulin with glucose must prevent resultant hypokalemia and hypophosphatemia labs may show pseudo-hyperkalemia prior to administartion of fluid and insulin due to transcellular shift of potassium out of the cells to balance the H+ being transfered into the cells Upon administration of insulin, potassium will shift intracellularly, possibly resulting in dangerous hypokalemia Long lasting insulin after the anion gap has closed during initial treatment Prognosis, Prevention, and Complications 5-10% mortality Life-threatening mucormycosis thrive in ketoacidotic state Rhizopus infection Cerebral edema Cardiac arrhythmias due to electrolyte imbalances Heart failure due to hypovolemia
QUESTIONS 1 of 9 1 2 3 4 5 6 7 8 9 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.13.51) An 8-year-old boy is brought to the emergency department with severe dyspnea, fatigue, and vomiting. His mother reports that he has been lethargic for the last several days with an increase in urine output. She thinks he may even be losing weight, despite eating and drinking more than normal for the last couple weeks. Laboratory results are notable for glucose of 440, potassium of 5.8, pH of 7.14 and HCO3 of 17. After administrating IV fluids and insulin, which of the following would you expect? QID: 100567 Type & Select Correct Answer 1 Increase in serum glucose 3% (4/133) 2 Increase in anion gap 6% (8/133) 3 Decrease in serum potassium 83% (110/133) 4 Decrease in pH 1% (1/133) 5 Decrease in serum bicarbonate 5% (7/133) M 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (M1.EC.12.38) A 14-year-old female with no past medical history presents to the emergency department with nausea and abdominal pain. On physical examination, her blood pressure is 78/65, her respiratory rate is 30, her breath has a fruity odor, and capillary refill is > 3 seconds. Serum glucose is 820 mg/dL. After starting IV fluids, what is the next best step in the management of this patient? QID: 100339 Type & Select Correct Answer 1 Intravenous regular insulin 76% (421/555) 2 Subcutaneous insulin glargine 5% (25/555) 3 Subcutaneous insulin lispro 10% (58/555) 4 Intravenous Dextrose in water 4% (23/555) 5 Intravenous glucagon 2% (11/555) M 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (M1.EC.12.101) A 20-year-old male is brought by ambulance to the emergency room in extremis. He is minimally conscious, hypotensive, and tachypneic, and his breath gives off a "fruity" odor. An arterial blood gas and metabolic panel show anion gap metabolic acidosis. This patient is most likely deficient in which of the following metabolic actions? QID: 100402 Type & Select Correct Answer 1 Formation of ketone bodies 14% (24/167) 2 Glucose production 4% (7/167) 3 Cortisol secretion 1% (2/167) 4 Cellular uptake of glucose 77% (128/167) 5 Glucagon production 2% (3/167) M 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (M1.EC.12.31) A 17-year-old male presents to your office complaining of polyuria, polydipsia, and unintentional weight loss of 12 pounds over the past 3 months. On physical examination, the patient is tachypneic with labored breathing. Which of the following electrolyte abnormalities would you most likely observe in this patient? QID: 100332 Type & Select Correct Answer 1 Alkalemia 6% (8/125) 2 Hyperkalemia 75% (94/125) 3 Hypoglycemia 9% (11/125) 4 Hypermagnesemia 2% (2/125) 5 Hyperphosphatemia 5% (6/125) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (1) Login to View Community Videos Login to View Community Videos DKA Gio Sabal Endocrine - Diabetic Ketoacidosis (DKA) D 8/28/2015 145 views 5.0 (5) Endocrine | Diabetic Ketoacidosis (DKA) Endocrine - Diabetic Ketoacidosis (DKA) Listen Now 17:30 min 5/31/2021 237 plays 4.5 (2)