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Diabetic ketoacidosis clinical features & management
- 1. DIABETIC KETOACIDOSIS CLINICAL FEATURES & MANAGEMENT Hanumath Yallanki
- 2. Clinical features Signs Tachycardia Dehydration/hypotensi on Tachypnea/Kussmaul respiration Abdominal tenderness Lethargy/Cerebral edema/Coma Smell of acetone Symptoms Nausea/vomiting Thirst/polyuria Abdominal pain SOB
- 3. Precipitating events Inadequate insulin Infection Drugs- cocaine Pregnancy
- 4. Investigations DKA is characterized by Hyperglycemia : >250 mg/dl (250-600) Ketosis Ketonuria >2+ Ketonemia >3meq/L Beta OH butyrate – reflects serum ketone levels Metabolic acidosis Arterial pH : 6.8 - 7.3 Anion gap : increased
- 5. Other Investigations Venous blood Urea and electrolytes ECG Infection screen CBP Blood & urine culture CRP Chest x-ray Note : Leucocytosis – stress response
- 6. Na+ : 125-135 meq/L Due to hyperglyceremia 1.6 meq/L for every 100 mg/dl rise in glucose Serum K+ : Normal / increased Total body : decreased Serum : increased Osmolality : 300-320 mosm/kg Serum bicarbonate : <15 meq/L Serum creatinine : slightly increased Hypertriglyceridemia, hyperlipoproteinemia Hyperamylasemia – salivary
- 8. Treatment
- 10. Insulin Blood glucose should fall by 55-110 mg/dl/hr Shift to SC route as soon as patient resumes eating If initial serum K+ : <3.3 meq/L, then give insulin only after K+ correction Potassium During treatment, serum K+ depletes due to Insulin Resolution of acidosis Urinary loss Goal : >3.5 meq/L
- 11. Prevention Frequently measure capillary glucose Measure urinary ketones when glu > 300mg/dl Drink fluids Continue or increase insulin Seek medical attention if dehydration, vomitings and hyperglycemia persist
- 12. Thank you