Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 24 2021

Diabetic Ketoacidosis (DKA)

  • 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
1 of 0
1 of 9
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options