Dr Woods DKA and HHS

1 DKA is most common in which type of diabetes?

Type 1 diabetes

2 The most frequent precipitating factor for DKA is

Infection

3 Main hormones elevated during DKA include

Glucagon, catecholamines, cortisol, growth hormone

4 Primary biochemical triad of DKA

Hyperglycemia, ketosis, metabolic acidosis

5 The anion gap equation is

[Na - (Cl + HCO₃)]

6 Normal anion gap range

8-12 mEq/L

7 Typical plasma glucose cutoff for diagnosing DKA

>250 mg/dL

8 The hallmark of HHS compared to DKA is

Severe hyperosmolarity without significant ketosis

9 Most common patient population for HHS

Older adults with type 2 diabetes

10 Serum osmolality equation

2(Na + K) + glucose/18 + BUN/2.8

11 Effective serum osmolality cutoff for HHS diagnosis

>320 mOsm/kg

12 Corrected sodium formula

Measured Na + 1.6((glucose-100)/100)

13 First treatment step for both DKA and HHS

Fluid resuscitation

14 Initial fluid used in DKA management

0.9% normal saline (1-1.5 L in first hour)

15 When to switch from 0.9% to 0.45% NaCl in DKA

When corrected Na is normal or elevated

16 When to add dextrose to IV fluids in DKA

When BG <200 mg/dL

17 Approximate fall in glucose per hour from fluids alone

20-25 mg/dL per hour

18 Potassium replacement should begin when serum K is

3.3-5.0 mEq/L

19 Insulin should be held until

K reaches at least 3.3 mEq/L

20 Standard insulin infusion dosing in DKA

0.1 u/kg bolus then 0.1 u/kg/h infusion (or 0.14 u/kg/h no bolus)

21 Target glucose reduction rate during insulin therapy

50-75 mg/dL per hour

22 Bicarbonate therapy is indicated only

when pH is <6.9

23 Phosphate replacement is recommended only if level is <1 mg/dL or patient symptomatic

24 DKA is considered resolved when

BG <200 plus Two of: HCO₃ ≥15, pH >7.3, anion gap ≤12

25 Before stopping insulin infusion, administer basal insulin

1-2 hours prior (2-3 h for long/intermediate-acting)

26 Common complications of DKA treatment include

Hypokalemia, hypoglycemia, cerebral edema

27 Approximate total body water deficit in DKA

~6 L

28 Approximate total body water deficit in HHS

8-12 L

29 Key difference in pathophysiology between DKA and HHS

Presence vs absence of ketoacidosis

30 Mortality rate comparison between DKA and HHS

HHS has higher mortality

31 Target glucose range during treatment of HHS after stabilization

250-300 mg/dL

32 Primary cause of altered mental status in HHS

Hyperosmolarity and dehydration

33 Common thrombotic complications seen in HHS

Stroke, myocardial infarction, pulmonary embolism

34 Definition of inpatient hyperglycemia

Any BG >140 mg/dL

35 Target glucose range for most non-critical inpatients

100-180 mg/dL

36 Target glucose range for critically ill inpatients

140-180 mg/dL

37 Glycemic goal for all hospitalized patients (per ADA)

<180 mg/dL

38 Preferred inpatient therapy for hyperglycemia

Insulin

39 Why oral antidiabetics are avoided inpatient

Unpredictable intake, contraindications, slow titration

40 Metformin should be held when eGFR

<30 or 48 h after IV contrast

41 Sulfonylureas are avoided inpatient because of

Hypoglycemia risk

42 TZDs are not used inpatient due to

Fluid retention and delayed onset

43 Insulin regimen preferred for non-ICU patients

Basal-bolus-correction regimen

44 Approximate TDD of insulin to initiate in most adults

0.5 units/kg/day

45 Proportion of basal vs bolus insulin

50% basal, 50% bolus

46 Correction-only insulin should not be continued longer than

24 hours

47 In NPO patients, the insulin plan is

Basal + correction only (no bolus)

48 In enteral nutrition with continuous feeds, insulin is given

Basal + bolus q4-6h + correction q4-6h

49 Treatment for inpatient hypoglycemia if conscious

15 g fast-acting carbohydrate

50 Treatment for inpatient hypoglycemia if unconscious/NPO

25-50 mL D50 IV push