Diabetic Ketoacidosis DKA PHCL 442 Lab Discussion 6 Raniah Al-Jaizani M.Sc

Introduction DKA is a serious, acute, metabolic complication of diabetes mellitus (DM) Usually in type I DM Mortality rate up to 5%

Precipitating Factors Infections Omissions or inadequate insulin therapy

Pathogenesis Reduction in effective concentrations of circulating insulin Elevation of counter regulatory hormones:  Catecholamines  Glucagon  Growth Hormone  Cortisol

Pathogenesis These hormonal alterations will cause:  glycogenolysis gluconeogenesis & peripheral glucose use Hyperglycemia  Promote breakdown of triglycerides and free fatty acids Ketone production

Diagnosis Clinical presentation: Polyuria Polydypsia Abdominal pain Nausea & vomiting Fruity breath Dry mucosa memberan

Diagnosis Laboratory findings: Blood Glucose (BG) > 250 mg/dl pH Mild ( ) Moderate (7-7.24) Sever < 7 Serum HCO3 ־ < 15 mmol/l ketones: Present in urine and blood WBCs 15,000-40,000cells/mm even without evidence of infection

Treatment Is aimed at correction of dehydration, hyperglycemia, ketoacidosis, and electrolyte deficits – Fluid replacement – IV insulin – Potassium replacement

Treatment Start IV fluids (1.0 L of 0.9% NaCl per hour initially) IV fluidsInsulinK HCO3־ Low Na High or normal Na 0.45%0.9% NaCl 4-14 ml/kg/hr IV bolus 0.15 U/kg IV infusion 0.1 U/kg hourly <3.3 mmol/L Hold insulin ≥5 mmol/L Not give K <5 mmol/L Give K mmol/L When pH < mEq HCO3־ to a liter of fluid until pH >7 Until blood glucose is ≤250 mg/dL

Treatment IV fluidsInsulin Until blood glucose is ≤250 mg/dL Change to 5% Dextrose with 0.45% NaCl Decrease insulin to 0.05 U/kg/hr Until resolution of ketoacidosis Defined by Plasma glucose level <11 mmol/L HCO3־ >18 mEq/L pH >7.3 Anion gap <14 mEq/L