Diabetic Ketoacidosis
Definition
Hyperglycaemia + Ketosis + Acidosis + dehydration
Epidemiology
Occurs usually in T1DM
Aetiology
Pathophysiology
No insulin
Hyperglycaemia + Ketosis + Acidosis + dehydration
Epidemiology
Occurs usually in T1DM
Aetiology
- Lack of insulin (non-adherence, dosage)
- Stress (infection, surg)
- Drugs (CS)
Pathophysiology
No insulin
- --> cells cannot absorb glucose --(so to get ATP) --> adipocytes breakdown TG to FFA --> Liver converts FFA to ketones --> inc ketones in blood
- --> hyperglycaemia --> kidneys unable to retain glucose --> Na leak together (pseudohypoNa) --> K leak too --> dehydration + hypoNA + hypoK
Clinical Features
Investigations
Bedside: Urinalysis (glu + ketones)
Bloods: BSL, UEC (Na/K inc - due 2o shift ICF-ECF/ renal function), CMP (hypoPO4), ABG (metabolic acidosis)
Management
Source
Toronto Notes 2012
- N+V (ketones in brain)
- Kussmal breathing (deep unlaboured breathing) = acidosis
- Dehydration (polydipsia/ uria, dec skin turgor)
- Fruity breath (ketones)
- LOC, coma, death
Investigations
Bedside: Urinalysis (glu + ketones)
Bloods: BSL, UEC (Na/K inc - due 2o shift ICF-ECF/ renal function), CMP (hypoPO4), ABG (metabolic acidosis)
Management
- DRSABCDE (NOTE: Do not give insulin bolus to prevent hypoK)
- Dehydration: N saline resus
- Acidosis: insulin infusion (0.1U/kg/h)
- Electrolytes: K+ (dec past 5.5) as ECF --> ICF, HCO3 only if pH <7.1 to avoid alkalosis
- +/- mannitol for cerebral oedema
Source
Toronto Notes 2012