07 S P M P On Diabetic Ketoacidosis


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07 S P M P On Diabetic Ketoacidosis

  1. 1. SPMP ON DIABETIC KETOSIS<br />Dr. S. Aswini Kumar.MD.<br />A 21 year-old woman is brought to the Accident & Emergency Department having been generally unwell for 2 weeks<br />VII. 01. Diagnosis of DKA can be suspected from the following EXCEPT:<br />Thirst, polyuria, polydypsia and nocturia <br />General weakness, malaise and lethargy<br />Nausea, vomiting and abdominal pain<br />Increased sweating, palpitation and giddiness<br />Symptoms of associated infections<br />VII. 02. Following signs are helpful in the diagnosis of DKA, EXCEPT:<br />Emaciated patient with an ill look<br />Dry skin, mucus membrane and increased skin turgor <br />Patient remaining fully conscious throughout<br />Tachycardia, tachypnoea, and hypotension<br />Breath which has fruity smell of acetone<br />VII. 03. Various precipitating factors for DKA are the following EXCEPT:<br />Missed insulin treatment<br />Underlying infection <br />Newly diagnosed, Type 2 DM<br />Stress situations like Trauma, Surgery or MI<br />Failure to appreciate symptoms of poor control of DM<br />VII. 04. The immediate differential diagnosis to be considered is:<br />Hyper Osmolar Non Ketotic Coma<br />Acute hypoglycemia<br />Alcoholic ketoacidosis <br />Acute appendicitis <br />All of the above<br />VII. 05. Following are in accordance with the diagnosis of DKA EXCEPT:<br />Glycosuria <br />Ketonuria <br />Hyperglycemia<br />Hypernatremia <br />Increased serum bicarbonate level<br />VII. 06. The general measures useful in the treatment of DKA are the following EXCEPT:<br />Feeding by mouth for at least six hours<br />Insertion of a nasogastric tube<br />Insertion of an indwelling catheter<br />Insertion of a central line <br />Arterial line to monitor ABGs<br />VII. 07. The components of treatment are the following EXCEPT:<br />The administration of modified insulin <br />Fluid replacement<br />Potassium replacement<br />The administration of antibiotics <br />Constant monitoring of metabolic parameters<br />VII. 08. The following statement about IV fluids in DKA is NOT TRUE:<br />It is a must since oral fluids may be poorly absorbed.<br />Or else insulin will not reach poorly perfused tissues.<br />Average fluid deficit is 6 liters; <br />1 liter is from intracellular compartment <br />Caution in patients with compromised CVS<br />VII. 09. The deficit of extra-cellular fluid must be made good by infusing: <br />0.9% isotonic saline<br />5.0% Dextrose saline<br />Ringer lactate solution<br />5.0% Dextrose solution<br />20% Mannitol solution<br />VII. 10. The blood sugar level at which the saline infusion is to be substituted with 5% Dextrose saline is<br />550mg%<br />450mg%<br />350mg%<br />250mg%<br />150mg%<br />VII. (11). Following modes of insulin administration are acceptable EXCEPT:<br />A. Loading dose of 10-20 units of regular insulin IM.<br />B. 4 units of regular insulin hourly thereafter by SC <br />C. Insulin infusion preferably using infusion pump<br />D. If no fall in RBS by 2 hours IV insulin is doubled<br />E. When RBS is 250 mg, insulin is to 2-4 units/hr<br />VII. (12). The following statements regarding the administration of potassium are true EXCEPT:<br />A. Total K+deficit is 1-2meq/kg irrespective of initial levels<br />B. If initial S K+ is <3.3 meq administer K+ before insulin<br />C. If S K+ <3.3meq/L give 40 meq of K+ till it is 3.3meq/L <br />D. If S K+ <3.3-5.5 give 20 meq of K+ in anticipation<br />E. If S K+ >5.5 with hold K+ and monitor K+ every 2hours<br />VII. (13). The following statements about bicarbonate are true, EXCEPT:<br />A. In severe acidosis give sodium bicarbonate (1.4%)<br />B. Correction of total bicarbonate deficit not attempted<br />C. Rapid correction may aggravate tissue hypoxia <br />D. It may cause a paradoxical acidosis of CSF<br />E. Bicarbonate + insulin risk of Hyperkalemia<br />VII. (14). Findings suggestive of poor prognosis in DKA include the following EXCEPT:<br />A. Impaired consciousness level<br />B. pH less than 7.0<br />C. Oliguria<br />D. Low potassium at presentation <br />E. Anion gap less than 10<br />VII. (15). The causes of death in DKA are the following EXCEPT:<br />A. Hyperkalemia<br />B. Hypokalemic respiratory arrest<br />C. Aspiration due to gastric stasis<br />D. Cerebral edema due to acidosis <br />E. Overhydration<br />VII. (16). The following facts are true regarding cerebral edema due to treatment are true EXCEPT:<br />A. Develops more commonly in patients <20 years<br />B. Serum osmolality ↓ by more than 3mOsm/kg/h<br />C. IV mannitol is found to be beneficial in such cases.<br />D. The dose of mannitol is 0.25-1.0g/kg in 20 minutes <br />E. Hypertonic saline can be used alternatevly<br />VII. (17). The following additional treatment is essential EXCEPT:<br />A. IV line with cannula or large bore needle<br />B. Catheterization after 3 hours if no urine is passed.<br />C. RBS & electrolytes hourly X3h and then 4 hourly.<br />D. Nasogastric tube to feed the patient <br />E. CVP line if CVS is compromised<br />