CM II 6 DKA Endo

2 ways to be insulin deficient

1. pancreas diseased

2. cells of body resistant to insulin

→ tissues cannot take up sugar needed for energy

insulin has what role?

• prevents breakdown of lipids in adipose tissue

• breakdown of muscles (protein catabolism)

• liver → prevents glucogenesis (creation of new sugar) and prevent glycongenolysis (breakdown of glycogen, storage form)

what are counterregulatory hormones to insulin?

• glucagon

• epinephrine

• cortisol

• GH

what are the results of insulin def?

• hyperglycemia

• ketoacidosis → DKA

• polyphagia

• polyuria (ketone and glucose in urine) and polydipsia

what are the 3 ketones produced?

1. acetate (acetoacetic acid)

2. beta-hydroxybutyrate

3. acetone

what is the normal ratio of beta and acetoacetate in acute DKA?

10:1

what are ketone bodies?

produced by liver, used as energy source when no glucose

nitroprusside test (on urine dipstick) detects what in urine?

AcAc and acetone (underestimates)

what is hyperosmolar hyperglycemic non-ketotic syndrome (HHNKS)?

• severe hyperglycemia and plasma hyperosmolarity

• ABSENCE of significant ketosis

• serum pH is low but does not reach the level of acidity in DKA

when does HHNKS occur?

in type II diabetics in setting of physiologic stress (drugs, infection, lack of insulin, etc)

absolute insulin vs. relative insulin def pH

absolute: pH < 7.3

relative: pH > 7.3

what should you do to correct hyperglycemia?

• initial bollus dose of 0.1 units/kg with infusion of 0.1 units/kg per hour

• once at 200 mg per dL = glucose hour, you can add IV fluids to maintain

how fast should glucose level decrease when you are giving them IV infusion?

50-70 mg/dL per hour

how long should you keep IV insulin in?

1-2 hours after subq insulin initiated

what is the relationship of potassium and DKA?

total body potassium is VERY low but because there’s dec insulin and volume = elevated extracellular concentration (so watch it!)

when would you start insulin WITHOUT K+?

if potassium level > 5.2 mEg/L

wwhat do you do if potassium level is “nomrmal?”

it’s not actually normal, so you should add potassium with insulin (do NOT add if potassium lower than 3.3 mEg/L)

what electrolyte may go down as a result of tx of DKA?

phosphate levels