DKA & HHS

Diabetic Ketoacidosis (DKA)**

What metabolic condition is caused by absolute insulin deficiency, leading to hyperglycemia, ketosis, and acidosis?

Hyperglycemia, Ketosis, Metabolic Acidosis**

What are the three hallmark features (triad) of DKA?

Hyperglycemic Hyperosmolar State (HHS)**

What hyperglycemic state occurs due to relative insulin deficiency with enough insulin to prevent lipolysis?

Uninhibited gluconeogenesis**

What process allows glucose to remain in the bloodstream due to impaired glycogenesis and glycolysis?

Presence of enough circulating insulin**

What prevents ketosis from occurring in HHS?

Kussmaul’s respirations**

What type of respirations are deep, rapid, and unlabored — a compensatory mechanism for metabolic acidosis?

Lipolysis**

What metabolic process leads to the accumulation of ketone bodies in DKA?

Osmotic diuresis**

What term refers to excessive urination caused by high glucose concentration pulling water out via the kidneys?

Cation exchange**

What electrolyte exchange occurs in acidosis when H⁺ enters the cell and K⁺ moves out?

(Na⁺ + K⁺) – (Cl⁻ + HCO₃⁻)**

What is the formula used to calculate the anion gap?

Infection or acute illness (e.g., MI, stroke)**

What is the most common precipitating factor for HHS?

Missed or decreased insulin administration**

What event may cause DKA if the patient skips their insulin dose?

HHS**

What condition can develop secondary to infection, myocardial infarction, or stroke in elderly diabetics?

Thiazide diuretics, glucocorticoids, Dilantin, sympathomimetics**

What types of medications may trigger DKA by increasing glucose levels?

DKA**

What may be the first manifestation of undiagnosed Type 1 Diabetes?

Dialysis or surgery**

What medical procedures can precipitate HHS in susceptible patients?

Polyuria, Polydipsia, Polyphagia**

What are the three classic poly-symptoms of diabetes?

Fruity or acetone breath**

What type of breath odor indicates ketosis?

Kussmaul’s respirations**

What breathing pattern compensates for metabolic acidosis in DKA?

Dehydration from osmotic diuresis**

What causes orthostatic hypotension in patients with DKA?

Delirium or altered level of consciousness**

What neurological sign results from cerebral dehydration in HHS?

T3D

What acronym summarizes the manifestations of HHS (Tachycardia, Dizzy, Dehydrated, Delirium)?

Dehydration due to osmotic diuresis**

What severe fluid imbalance may cause a loss of up to 6.5 L of water within 24 hours in DKA?

Altered level of consciousness (DKA coma)**

What late manifestation of DKA may progress to coma if untreated?

HHS**

What condition typically has a slow, gradual onset before neurologic symptoms appear?

250–600 mg/dL**

What is the typical blood glucose range seen in DKA?

>600 mg/dL**

What blood glucose value indicates HHS?

300–320 mOsm/kg**

What serum osmolality range is observed in DKA?

>320 mOsm/kg**

What serum osmolality level indicates HHS?

8–16 mEq/L**

What is the normal range for anion gap?

Anion gap**

What lab value is increased in DKA due to ketoacidosis?

Presence of ketones in blood and urine**

What diagnostic finding distinguishes DKA from HHS?

Hypernatremia**

What electrolyte imbalance is common in HHS due to dehydration?

Dilutional hyponatremia**

What electrolyte imbalance occurs in DKA due to water shifting into the extracellular space?

Pre-renal acute kidney injury (AKI)**

What renal complication may develop due to dehydration in both DKA and HHS?

Decreased pCO₂*

What arterial blood gas change occurs in DKA due to respiratory compensation?

Hemoconcentration**

What CBC finding indicates dehydration in DKA and HHS?

Fluid replacement therapy**

What is the first line of management for both DKA and HHS?

Fluids → Electrolytes → Insulin**

What is the correct sequence of management steps for both emergencies?

0.9% Normal Saline (Isotonic)**

What IV fluid is used initially to correct intravascular dehydration?

0.45% Normal Saline (Hypotonic)**

After initial hydration, what IV fluid is used to treat intracellular dehydration?

Dextrose-based IV fluid (e.g., D5NS or D5½NS)**

When blood glucose reaches ≤250 mg/dL (DKA) or ≤300 mg/dL (HHS), what type of IV fluid should be started to prevent hypoglycemia?

Regular insulin**

What is the only insulin that can be given intravenously?

0.1 unit/kg bolus, then 0.1 unit/kg/hr infusion**

What is the standard bolus and infusion rate of insulin for DKA treatment?

Potassium (K⁺)**

What electrolyte should be monitored closely during insulin therapy?

Hypokalemia**

What complication can occur after insulin infusion due to potassium shifting into cells?

When pH is <6.9–7.1**

When is bicarbonate therapy (NaHCO₃) indicated in DKA management?

4–5 mEq/L**

Before starting insulin, what potassium level must be maintained?

Central Venous Pressure (CVP)**

What monitoring tool is used in HHS to avoid fluid overload and CHF during resuscitation?

When the patient can eat and the anion gap is normal (8–16)**

When can insulin infusion be discontinued in DKA management?

40 mEq/hr**

At what rate should IV potassium chloride (KCl) be infused?

Every 1–2 hours**

How often should blood glucose be monitored during insulin infusion?

Never stop insulin; take usual dose and maintain hydration**

What is the “sick day rule” for diabetics experiencing vomiting or illness?

Plasma expander (Albumin)**

What may be used to correct severe hypotension unresponsive to IV fluids?

Hypokalemia**

What electrolyte disturbance causes flat or inverted T waves and U waves on ECG?

Cerebral edema**

What serious complication may result from overhydration during DKA or HHS treatment?

Cushing’s triad, headache, change in LOC**

What signs indicate cerebral edema due to fluid overload?

Hypoglycemia**

What metabolic complication can occur if insulin is given too rapidly?

Congestive Heart Failure (CHF)**

What cardiovascular complication may occur during fluid therapy in HHS?

Pre-renal Acute Kidney Injury (AKI)**

What renal complication may result from severe dehydration in both DKA and HHS?