DKA Basics
-Definition: Blood glucose >250 (e.g. diabetic), moderate ketonemia, anion gap >10, Bicarbonate <15, and pH <7.3 (acidosis)
-Definition: Blood glucose >250 (e.g. diabetic), moderate ketonemia, anion gap >10, Bicarbonate <15, and pH <7.3 (acidosis)
-Metabolic acidosis, hyperglycemia, hyperosmolality, potassium depletion, and hypovolemia
-Infection is often a precipitating event
Initial Labwork:
-Serum electrolytes
-Calculate Anion gap
-CBC
-UA
-Plasma osmolality
-ABG
-EKG
-Blood cultures, urinalysis, CXR to determine possible infectious cause
-CBC
-UA
-Plasma osmolality
-ABG
-EKG
-Blood cultures, urinalysis, CXR to determine possible infectious cause
Hyperglycemia and Serum Sodium:
-Corrected Serum Na = Measured Na + 0.024 * (Serum glucose - 100)
-boils down to this: add 1.2 to the sodium for every 50 mg/dL over 100
Management:
Order of priorities is volume first, correction of potassium deficits, and then insulin administration
1. ABCs
2. get labwork and investigate source of DKA/HHS (infectious causes)
3. Fluid resuscitation with isotonic saline (Increases insulin responsiveness by lowering plasma osmolality)
4. Insulin therapy (after confirmation of potassium greater than 3.3) --bolus of Regular Insulin IV followed by an insulin drip
5. KCl is generally added to the replacement fluid once the serum K+ falls below 5.3
6. When the serum glucose reaches 200 in DKA or 250-300 in HHS, saline is switched to dextrose containing solution
NOTE: Use of supplemental bicarbonate in the DKA is not recommended
6. When the serum glucose reaches 200 in DKA or 250-300 in HHS, saline is switched to dextrose containing solution
NOTE: Use of supplemental bicarbonate in the DKA is not recommended
Submitted by J. Grover.
Reference(s): Tintinalli’s 7th edition, uptodate.com, picture
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