DKA

DKA

• diabetic ketoacidosis

• potentially life threatening complication of diabetes mellitus resulting from the consequences of insulin deficiency with conterregulatory hormone excess

test and labs

• CBC

• BMP

• Blood glucose

• Serum ketones

• Mg phos

• VBG/ABG

• Consider ECG/UA, CXR, cultures (to rule out percipitant)

Classic triad

• Acidosis

• Hyperglycemia

• Ketonemia

Acidosis

• venous pH<7.3 or

• HCO3 <18

• Elevated anion gap

Hyperglycemia

• Serum glucose >200 mg/dL

Ketonemia

• Ketones >3 mmol/L or

• Ketonuria

History and physical exam

• Polydipsia

• ABD pain

• N/V

• Fruity smell on breath

• Altered LOC

• DM medication non compliance

• Polyuria → decreased urinary output

• Signs of dehydration

• Tachypnea

• May be the first presentation of unrecognized T1DM

• Percipitant (infection, PNA, MI)

Pearl: The potassium paradox

Serum K+ may be normal or high but total body potassium is LOW

DKA in peds

• common presentation for new onset T1DM

• Higher risk for cerebral edema

• Avoid rapid glucose shifts

DKA management

• 20-30 cc/kg lactated ringers bolus during the first hour (when blood glucose < 250-300 add a D10 infusion)

• Electrolyte repletion (Potassium is most important)

• Insuling (to treat hyperglycemia)

• Bicard (to treat metabolic acidosis)