DKA

The low pH of the ketone bodies (energy in absence of glucose) causes..

METABOLIC ACIDOSIS

What creates ketone bodies?

the LIVER converts fatty acids to ketone bodies (energy in absence of glucose)

Gluconeogenesis

breaks down stored glycogen into glucose, providing a quick energy source (in the liver)

Glycogenolysis

creates new glucose from non-carbohydrate precursors like amino acids, lactate, and glycerol

Result of gluconeogenesis and glycogenolysis

SEVERE hyperglycemia → hyperosmolality (blood saturated with glucose) → osmotic diuresis (body trying to flush out glucose) → Dehydration

What electrolyte imbalances are common in DKA?

Hyper/hypo KALEMIA

Dilutional hyponatremia

Vital signs in DKA

Volume loss (FVD)

• HYPOtension

• TACHYcardia 

Respirations in DKA

KUSSMAUL → Rapid and deep → comp for acidosis → blow off CO2 → acetone/fruity breath of the ketones

Why may there be nausea and vomiting?

trying to get rid of the acid

Glucose, pH, anion gap, and bicarb in DKA

Glucose: >250 (400-600)

pH: <7.3 (acidic)

Bicarb: <18

Positive anion gap

Urine in DKA

Ketones in urine

IV fluids in DKA

Isotonic normal saline (0.9%) BOLUS to start

What may the IV fluids progress to if the patient is severely dehydrated?

0.45% NS to hydrate cells

When is 5% dextrose added to the 0.45 NS?

Glucose at 250-300mg

Why should the glucose be brought down gradually?

Prevent cerebral edema and IICP

What must be corrected before the administration of insulin IV?

decreased potassium → insulin will draw K+ back into the cell → admin potassium solution IV to combat

What should be avoided with potassium admin?

IV PUSH → NO IV PUSH K+

What type of insulin is given IV?

Regular