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Question-and-answer flashcards covering definitions, diagnosis, pathophysiology, clinical presentation, treatment steps, monitoring, and common pitfalls for diabetic ketoacidosis (DKA) and hyperosmolar-hyperglycemic state (HHS).
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What plasma glucose level meets the ADA hyperglycemia criterion for DKA?
≥ 200 mg/dL
What plasma glucose level meets the ADA hyperglycemia criterion for HHS?
≥ 600 mg/dL
Which two laboratory values confirm metabolic acidosis in DKA?
Arterial pH < 7.3 and/or serum bicarbonate < 18 mmol/L
What osmolality values define hyperosmolarity in HHS?
Effective serum osmolality > 300 mOsm/kg or total osmolality > 320 mOsm/kg
Which ketone body is preferred for diagnosing DKA?
β-hydroxybutyrate (BHB)
A BHB value of indicates significant ketosis in DKA.
≥ 3.0 mmol/L
List the three ketone bodies produced during DKA.
Acetoacetate, β-hydroxybutyrate, and acetone
Which antihyperglycemic drug class can precipitate euglycemic DKA?
SGLT-2 inhibitors
Name the six precipitating “I’s” of DKA/HHS.
Insulin deficiency, Infection, Inflammation, Intoxication, Infarction, Iatrogenic
Give two classic symptoms common to both DKA and HHS.
Polyuria and polydipsia (weight loss, dehydration, vomiting, weakness are also common)
How does the onset of DKA differ from HHS?
DKA develops within hours to days; HHS develops over days to weeks.
What type of breathing pattern is characteristic of severe DKA?
Kussmaul respirations (deep, rapid, labored)
What is the first therapeutic step in managing DKA/HHS?
Begin IV crystalloid fluid resuscitation.
Typical initial infusion rate for NS or LR in DKA/HHS?
500–1000 mL/hr during the first 2–4 hrs (adjust for comorbidities).
Approximate drop in blood glucose from fluids alone before insulin?
50–70 mg/dL per hour.
When should dextrose (D5 or D10) be added to IV fluids in DKA?
When blood glucose falls below 250 mg/dL.
Target blood-glucose range after adding dextrose in DKA?
150–200 mg/dL.
Target blood-glucose range after adding dextrose in HHS?
200–250 mg/dL.
Why must serum potassium be checked before insulin is started?
Insulin drives K⁺ into cells, risking hypokalemia that can cause arrhythmias and muscle weakness.
Minimum serum K⁺ required before starting insulin therapy?
≥ 3.5 mEq/L.
Therapeutic goal range for serum potassium during treatment?
4–5 mEq/L.
Management step if K⁺ < 3.5 mEq/L at presentation?
Hold insulin, give IV KCl (10–20 mEq/hr) until K⁺ ≥ 3.5 mEq/L.
Recommended initial IV insulin infusion rate for DKA?
0.1 units/kg/hr of regular insulin.
Optional insulin bolus dose often given before the infusion?
0.1 units/kg IV once.
How should the insulin infusion be adjusted when BG < 250 mg/dL in DKA?
Reduce to 0.05 units/kg/hr.
Subcutaneous insulin option for mild DKA?
Rapid-acting insulin 0.1 units/kg SC every 1 hr (or 0.2 units/kg every 2 hrs).
Initial IV insulin infusion rate for HHS?
0.05 units/kg/hr.
List four key labs/parameters to monitor every 2–4 hrs during therapy.
Chem-7 (Na⁺, K⁺, bicarbonate, etc.), BUN/Cr, pH, blood glucose, plus urine output.
Resolution criteria for DKA?
pH > 7.3 or HCO₃ > 18 mmol/L and BHB < 0.6 mmol/L.
Resolution criteria for HHS?
Serum osmolality < 300 mOsm/kg, urine output > 0.5 mL/kg/hr, and BG < 250 mg/dL.
How long should IV insulin overlap with the first SC insulin dose?
1–2 hours to ensure adequate insulin levels.
Give two common clinician errors in DKA/HHS management.
1) Failing to add potassium initially, forcing insulin to be paused later. 2) Forgetting to reduce insulin rate when BG < 250 mg/dL or forgetting to add dextrose.
Why are premixed NS + KCl (± D5) bags advantageous?
They’re stocked on units, saving time and reducing compounding errors.
State the five major goals of therapy in hyperglycemic crises.
Correct fluid deficit, correct hyperglycemia/ketosis, maintain electrolytes, avoid therapy-related complications, treat underlying cause.
Provide the formula for effective serum osmolality.
Effective osmolality = (2 × Na⁺ [mEq/L]) + Glucose (mmol/L).
Convert a glucose of 600 mg/dL to mmol/L.
600 mg/dL ÷ 18 = 33.3 mmol/L.
Which patient population most commonly presents with DKA?
Individuals with type 1 diabetes (though rising in type 2).
Which patient population most commonly presents with HHS?
Elderly patients with type 2 diabetes.
Name two crystalloid solutions commonly used for initial resuscitation.
0.9% NaCl (Normal Saline) and Lactated Ringer’s.
What rare but serious complication can occur if glucose is lowered too quickly?
Cerebral edema.