Diabetic ketoacidosis

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Diabetic ketoacidosis

  1. 2. Definition L ab T reatment C omplications P athophysiology S igns and S ymptoms E tiology D iagnosis contents
  2. 3. <ul><li>Diabetic ketoacidosis is near complete deficency of insulin and elevated levels of stress hormones </li></ul><ul><li>glucagon </li></ul><ul><li>cathecolamine </li></ul><ul><li>cortisol </li></ul><ul><li>growth hormone </li></ul><ul><li>acute metabolic complication of diabetic characterized by </li></ul><ul><li>Hyperglycemia </li></ul><ul><li>hyperketonemia </li></ul><ul><li>metabolic acidosis </li></ul>Defination
  3. 4. DKA is a life - threatening comp DKA is a life - threatening complication in Pt. with untreated DM  (chronic high blood sugar or hyperglycemia). DKA occurs mostly in type 1 DM DKA is less common in type 2 DM, but it may occur in situations of physiologic stress . Pts . with new undiagnosed Type 1 DM  frequently present to hospitals with   DKA Definition
  4. 5. <ul><ul><li>  </li></ul></ul>Etiology <ul><li>Insulin deficiency   c relative or absolute increase </li></ul><ul><ul><li>in glucagon(Inadequate insulin administration) </li></ul></ul><ul><ul><li>Infection    or Inflammation ( pneumonia, UTI, </li></ul></ul><ul><ul><li>gastroenteritis, sepsis) </li></ul></ul><ul><ul><li>Ischemia or Infarction ( cerebral, coronary, mesenteric, </li></ul></ul><ul><ul><li>peripheral) </li></ul></ul><ul><ul><li>Intra - abdominal process (pancreatitis, cholecystitis) </li></ul></ul>
  5. 6.   1 . Hyperglycemia : gluconeogenesis, glycogenolysis ,↓glucose uptake into cell (underutilization)   2. Ketosis : lipolysis, ketogenesis , ↓ Peripheral tissue uptake ketone -- )ketonemia   3 . Hypertriglyceridemia   : ↑free fatty acid   4. Osmotic diuresis   : hyperglycemia -- ) renal loss glucose, Na & K -- )electrolyte imbalance   5 . Volume depletion   : hyperglycemia, glucosuria & osmotic diuresis -- )dehydration   Pathophysiology
  6. 7. <ul><li>S igns and S ymptoms    Initial symptoms of DKA </li></ul><ul><ul><li>Anorexia, nausea, vomiting, abdominal pain </li></ul></ul><ul><ul><li>Polyuria, polydipsia </li></ul></ul><ul><ul><li>Dehydration  -- ) dry mucous membranes, tachycardia, hypotension </li></ul></ul><ul><ul><li>Alterated mental function -- ) somnolence, stupor,coma </li></ul></ul><ul><ul><li>Fever is not a sign of DKA -- )signifies underlying infection </li></ul></ul><ul><li>  Classic signs of DKA </li></ul><ul><ul><li>Kussmaul  ‘ s respirations (deep)  to compensate for metabolic acidosis </li></ul></ul><ul><ul><li>with  acetone odor on Pt. breath </li></ul></ul><ul><li>  </li></ul>Signs and Symptoms
  7. 8.   การตรวจทางห้องปฏิบัติการเบื้องต้น 1 . Glucose & ketone in serum & urine 2 . Serum electrolyte, BUN, Cr, Ca, PO4 3 . Blood gas : capillary or arterial blood gas 4 . EKG : hypo / hyperkalemia 5 . CBC UA   Lab
  8. 9. Serum glucose ) 300 mg / dl                                          Acidosis : serum HCO3 < 15 mEq/ml  or pH < 7.25                                                     severity of DKA                                                                Mild           : HCO3    > 15-18 mq / L  & pH > 7.3                       Moderate  :   HCO3      10-15 mq / L & pH  7.1-7.3 Severe      :    HCO3  <  10mq / L &  pH<7.1                                Ketone : positive ketone in urine and / or ser u m   Diagnosis
  9. 10. <ul><li>    </li></ul><ul><li>Confirm Dx   : ↑ BS, positive serum ketone, metabolic acidosis </li></ul><ul><li>Admit </li></ul><ul><li>Assess </li></ul><ul><ul><li>Serum electrolyte : K, Na, Mg, Cl, HCO3, PO4 </li></ul></ul><ul><ul><li>Acid-base status :  pH, H CO3, Pco2 </li></ul></ul><ul><ul><li>Renal function : creatinine, urine output </li></ul></ul><ul><li>Replace fluid </li></ul><ul><li>Administer regular insulin / RI </li></ul><ul><li>Assess patient  </li></ul><ul><ul><li>What precipitated the episode </li></ul></ul><ul><ul><li>Initial appropriate work up </li></ul></ul>Treatment
  10. 11. <ul><li>Measure capillary glucose every 1-2 hr /   E ’lyte, anion gap every 4 hr for first 24 hr </li></ul><ul><li>  Monitor  BP, PR, respiration, mental status, fluid intake/output every 1-4 hr </li></ul><ul><li>  Replace K </li></ul><ul><li>Continue above until Pt . stable </li></ul><ul><li>  Administer intermediate or long – acting insulin as soon as Pt . eating                                 </li></ul><ul><li>    / overlap in insulin infusion & subcutaneous injection. </li></ul><ul><li>  </li></ul>Treatment
  11. 12. <ul><li>Hypolycemia </li></ul><ul><li>Electrolyte imbalance </li></ul><ul><li>Hyperlycemia </li></ul><ul><li>Metabolic acidosis </li></ul><ul><li>Cerebraledema </li></ul><ul><li>Hypoxemia,ARDS </li></ul><ul><li>Thrombotic events:CVA,MI </li></ul>Complication

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