The document discusses diabetic ketoacidosis (DKA), providing definitions, pathophysiology, precipitating events, symptoms, diagnosis, and treatment. DKA is defined as hyperglycemia, ketosis, and acidemia. It results from insulin deficiency leading to lipolysis, ketogenesis, and hyperglycemia. Common causes include infection, inadequate insulin, drugs like cocaine, and pregnancy. Treatment involves fluid resuscitation, insulin therapy to lower glucose levels to 140-180 mg/dL, electrolyte replacement, and treating the underlying precipitant once the patient is stabilized. Potassium levels require close monitoring during treatment.
Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin.
When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic.
Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin.
When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic.
Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria.
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
acute complication of diabetes mellitus. cardinal biochemical features for DKA. pathophysiology of DKA. clinical assesment of DKA. investigation and management for DKA. complications of DKA.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/11/diabetic-ketoacidosis.html
Diabetic Ketoacidosis, diabetus type 1 complection. diagnosisi and managment
Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria.
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
acute complication of diabetes mellitus. cardinal biochemical features for DKA. pathophysiology of DKA. clinical assesment of DKA. investigation and management for DKA. complications of DKA.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/11/diabetic-ketoacidosis.html
Diabetic Ketoacidosis, diabetus type 1 complection. diagnosisi and managment
Academic discussion/ Lecture class for 5th year MBBS students on Diabetic Emergencies, types, their sign-symptoms and managements. Most of the Data was taken from Davidson's Principles and Practice of Medicine.
This is the fifth lecture. it is based on guidelines by NHS UK. the guidelines based are freely available in internet. the source and the used literature are trusted and accurate. i hope this level of a knowledge about the management side of the DKA touches the all areas of patient survival. patho-physiology not discussed here but will be discussed in another lecture in details. to a intern and final year MBBS students or ERPM students must process a level of knowledge described by the lecture. definitely more you read more knowledge you get. get the idea in the lecture and principles of management. so you will be much accurate in a ward. always take superior advice while managing emergencies.
Diabetes mellitus (DM) is a common, chronic, metabolic syndrome characterized by hyperglycemia as a cardinal biochemical feature. The major forms of diabetes are classified according to those caused by deficiency of insulin secretion due to pancreatic β-cell damage (type 1 DM, or T1DM) and those that are a consequence of insulin resistance occurring at the level of skeletal muscle, liver, and adipose tissue, with various degrees of β-cell impairment (type 2 DM, or T2DM). T1DM is the most common endocrine-metabolic disorder of childhood and adolescence, with important consequences for physical and emotional development. Individuals with T1DM confront serious lifestyle alterations that include an absolute daily requirement for exogenous insulin, the need to monitor their own glucose level, and the need to pay attention to dietary intake. Morbidity and mortality stem from acute metabolic derangements and from long-term complications (usually in adulthood) that affect small and large vessels resulting in retinopathy, nephropathy, neuropathy, ischemic heart disease, and arterial obstruction with gangrene of the extremities. The acute clinical manifestations are due to hypoinsulinemic hyperglycemic ketoacidosis. Autoimmune mechanisms are factors in the genesis of T1DM; the long-term complications are related to metabolic disturbances (hyperglycemia).
Type 1 Diabetes Mellitus
Formerly called insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes, T1DM is characterized by low or absent levels of endogenously produced insulin and dependence on exogenous insulin to prevent development of ketoacidosis, an acute life-threatening complication of T1DM. The natural history includes 4 distinct stages: (1) preclinical β-cell autoimmunity with progressive defect of insulin secretion, (2) onset of clinical diabetes, (3) transient remission “honeymoon period,” and (4) established diabetes associated with acute and chronic complications and decreased life expectancy. The onset occurs predominantly in childhood, with median age of 7-15 yr, but it may present at any age. The incidence of T1DM has steadily increased in many parts of the world, including Europe and the USA. T1DM is characterized by autoimmune destruction of pancreatic islet β cells. Both genetic susceptibility and environmental factors contribute to the pathogenesis. Susceptibility to T1DM is genetically controlled by alleles of the major histocompatibility complex (MHC) class II genes expressing human leukocyte antigens (HLAs). It is also associated with autoantibodies to islet cell cytoplasm (ICA), insulin (IAA), antibodies to glutamic acid decarboxylase (GADA or GAD65), and ICA512 (IA2). T1DM is associated with other autoimmune diseases such as thyroiditis, celiac disease, multiple sclerosis, and Addison disease. There is some suggestion that high dietary intake of omega-3 polyunsaturated fatty acids and vitamin D supplementation in early childhood decreases the incidence of autoi
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. INTRODUCTION
HHS and DKA are not mutually exclusive but rather two
conditions that both result from some degree of insulin
deficiency.
They can and often do occur simultaneously. In fact, one
third of patients admitted for hyperglycemia exhibit
characteristics of both HHS and DKA.
14th edition of Joslin's Diabetes Mellitus
3. DEFINITION
DKA is defined as the presence of all three of the
following:
(i)
Hyperglycemia (glucose >250 mg/dL)
(ii)
Ketosis,
(iii)
Acidemia (pH <7.3).
14th edition of Joslin's Diabetes Mellitus
6. ROLE OF INSULIN
Required
for transport of glucose into:
Muscle
Adipose
Liver
Inhibits
lipolysis
Absence
of insulin
Glucose accumulates in the blood.
Uses amino acids for gluconeogenesis
Converts fatty acids into ketone bodies :
Acetone, Acetoacetate, β-hydroxybutyrate.
8. SYMPTOMS
DKA
PHYSICAL FINDINGS
can be the first
Dehydration/hypotension
presentation.
Tachypnea/kussmaul
Nausea/vomiting
Thirst/polyuria
Abdominal
pain
Shortnessof
Tachycardia
breath
respirations/respiratory
distress
Fruity odour in breath.
Abdominal tenderness(may
resemble acute pancreatitis or
surgical abdomen)
Lethargy/obtundation/cerebra
l edema/possibly coma.
Harrison’s Principle of internal medicine 18th edition p 2976
9. Differential Diagnosis of Ketosis and Anion Gap Acidosis
FEATURES
DIABETIC
ALCOHOL
STARVATION
URAEMIC
KETOACIDOSIS KETOACIDOSIS KETOACIDOSIS ACIDOSIS
LACTIC
ACIDOSIS
PH
PLASMA
GLUCOSE
ANION GAP
SERUM
KETONES
SERUM
OSMOLALITY
14th edition of Joslin's Diabetes Mellitus
10. DIAGNOSIS
INITIAL EVALUATION
Identify precipitating event leading to elevated glucose
(pregnancy, infection, omission of insulin, myocardial
infarction, central nervous system event)
Assess hemodynamic status
Examine for presence of infection
Assess volume status and degree of dehydration
Assess presence of ketonemia and acid-base disturbance
14th edition of Joslin's Diabetes Mellitus
11. DIAGNOSIS
LAB INVESTIGATIONS
Complete blood count
Serum ketones/ Urine ketones and sugar
Calculate serum osmolality and anion gap
Urinalysis and urine culture
Consider blood culture
Consider chest radiograph
Acid-base assessment
14th edition of Joslin's Diabetes Mellitus
12. LABORATORY VALUES IN DKA AND HHS
DKA
HHS
Glucose,mg/dl
250-600
600-1200
Sodium meq/L
125-135
135-145
Potassium
Normal to↑
Normal
Osmolality mosm/kg
300-320
330-380
Plasma ketones
++++
+/-
Serum bicarbonate
<15meq/L
Normal to slightly ↓
Arterial pH
6.8-7.3
>7.3
Arterial pCO2
20-30
Normal
Anion gap
↑
Normal to slightly↑
Harrison’s Principle of internal medicine 18th edition
14. TREATMENT OF DKA
Initial hospital management
Replace fluid and electrolytes
IV Insulin therapy
Watch for complications
Treat causes
Once resolved
Convert to home insulin regimen
Prevent recurrence
15.
16.
17.
18.
19.
20.
21.
22. FLUID REPLACEMENT
Administer NS as indicated to maintain hemodynamic
status, then follow general guidelines:
NS for first 4 hr.
Consider half NS thereafter.
Change to D5 half NS when blood glucose ≤250 mg/dL.
14th edition of Joslin's Diabetes Mellitus
23. FLUID REPLACEMENT CONTD…
Hours
1st half-hour to 1 hour
2nd hr
3rd hr
4th hr
5th hr
Total 1st 5 hr
6th–12th hr
Volume
1L
1L
500 mL– 1 L
500 mL– 1 L
500 mL– 1 L
3.5 - 5 L
250– 500 mL/hr
May need to adjust type and rate of fluid administration in the
elderly and in patients with congestive heart failure or renal failure.
14th edition of Joslin's Diabetes Mellitus
24. INSULIN MANAGEMENT
Regular insulin 10 U i.v. stat (for adults) or 0.15 U/kg i.v. stat.
Start regular insulin infusion 0.1 U/kg per hour or 5 U per hour.
Increase insulin by 1 U per hour every 1–2 hr if less than 10% decrease
in glucose or no improvement in acid-base status.
Decrease insulin by 1–2 U per hour (0.05–0.1 U/kg per hour) when
glucose ≤250 mg/dL and/or progressive improvement in clinical status
with decrease in glucose of >75 mg/dL per hour.
Do not decrease insulin infusion to <1 U per hour.
14th edition of Joslin's Diabetes Mellitus
25. INSULIN MANAGEMENT
CONTD…
Maintain glucose between 140 and 180 mg/dL.
If blood sugar decreases to <80 mg/dL, stop insulin infusion for no more
than 1 hr and restart infusion.
If glucose drops consistently to <100 mg/dL, change i.v. fluids to D10 to
maintain blood glucose between 140 and 180 mg/dL.
Once patient is able to eat, consider change to s.c. insulin:
Overlap short-acting insulin s.c. and continue i.v. infusion for 1–2 hr.
For patients with previous insulin dose: return to prior dose of insulin.
For patients with newly diagnosed diabetes: full-dose s.c. insulin based
on 0.6 U/kg per day.
14th edition of Joslin's Diabetes Mellitus
26. TREATMENT OF DKA
FLUIDS AND ELECTROLYTES
•
Sodium replacement
– Calculate effective serum sodium
– Serum sodium + 1.6 ( blood glucose-100)/100
–
isotonic saline (0.9% NaCl) is infused at a rate of 15–20
ml ·/ kg/ body wt /· h or greater during the 1st hour (∼1–
1.5 l in the average adult). Subsequent choice for fluid
replacement depends on the state of hydration, serum
electrolyte levels, and urinary output.
–
In general, 0.45% NaCl infused at 4–14 ml / kg/ h is
appropriate if the corrected serum sodium is normal or
elevated; 0.9% NaCl at a similar rate is appropriate if
corrected serum sodium is low.
Williams textbook of endocrinology 10th edition p 454
27. POTASSIUM REPLACEMENT
Do not administer potassium if serum potassium >5.5
mEq/L or patient is anuric.
Use KCl but alternate with KPO4 if there is severe
phosphate depletion and patient is unable to take
phosphate by mouth.
Add i.v. potassium to each liter of fluid administered unless
contraindicated.
Williams textbook of endocrinology 10th edition p 454
28. POTASSIUM REPLACEMENT CONTD…
Serum K (mEq/L)
Additional K required
<3.5 - 4.0
40 mEq/L
-
3.5–4.5
-
20 mEq/L.
4.5–5.5
-
10 mEq/L
>5.5
-
Stop K infusion
14th edition of Joslin's Diabetes Mellitus
29. PHOSPHATE
Hypophasphatemia may develop during increased
glucose usage
If serum level <1mg/dl then phosphate supplementation
considered and monitor for hypocalcemia and
hypomagnesemia
No benefit demonstrated in RCT .
Williams textbook of endocrinology 10th edition p456
30. BICARBONATE
Clinical trials donot support the rouine use of bicarbonate
replacement
HCO3 replacement and rapid reversal of acidosis can
impair cardiac function, reduce tissue oxygenation and
promote hypokalemia and hypocalcemia.
Williams textbook of endocrinology 10th edition p456
31. BICARBONATE
CONTD…
However in presence of sevare acidosis ph<6.9,in
hemodynamic instability with ph<7.1 and hyperkaemia
with ecg finding bicarbonate therapy considered .
In the presence of severe acidosis (arterial pH <6.9), the
ADA advises bicarbonate [50 mmol/L (meq/L) of sodium
bicarbonate in 200 mL of sterile water with 10 meq/L KCl
per hour for 2 h until the pH is >7.0].
Williams textbook of endocrinology 10th edition
32. TREATMENT OF DKA
GLUCOSE ADMINISTRATION
Plasma glucose reaches 250 mg/dl in DKA or 300 mg/dl
in HHS,
Decrease the insulin infusion rate to 0.05–0.1 unit/kg/h
(3–6 units/h),
Add dextrose (5–10%) to the intravenous fluids.
Maintain the above glucose values until acidosis in DKA or
mental obtundation and hyperosmolarity in HHS are
resolved
Williams textbook of endocrinology 10th edition p 455
33. MONITORING
Flow sheet mantained tabulating mental status,
vital signs,insulin dose,fluid and electrolyte
administered and urine output
Capillary glucose 1-2hrly,electrolytes especially
K+,bicarbonate and phosphate) and anion gap
every 4 hrly for first 24 hr
Monitor BP,pulse respiration fluid intake and output
every 1-4 h
Williams textbook of endocrinology 10th edition p 456
34. ONCE DKA RESOLVED…
•
Most patients require 0.5-0.6 units/kg/day
•
highly insulin resistant patients
–
•
0.8-1.0 units/kg/day
Give subcutaneous insulin at least 2 hours prior to
weaning insulin infusion.
Williams textbook of endocrinology 10th edition p455
35. COMPLICATIONS OF DKA
Shock
If not improving with fluids
MI
r/o
Cerebral
Vascular
thrombosis
Severe dehydration
Cerebral vessels
Occurs hours to days after DKA
Edema
First 24 hours
Mental status changes
May require intubation
with hyperventilation
Pulmonary
Edema
Result of aggressive fluid
resuscitation
14th edition of Joslin's Diabetes Mellitus
36.
37. CLINICAL ERRORS
Fluid shift and shock
Giving insulin without sufficient fluids
Using hypertonic glucose solutions
Hyperkalemia
Premature potassium administration before insulin has begun
to act
Hypokalemia
Failure to administer potassium once levels falling
Recurrent ketoacidosis
Premature discontinuation of insulin and fluid when ketones
still present
Hypoglycemia
Insufficient glucose administration.
39. DKA is defined as the presence of all three of the
following EXCEPT
1.
Hyperglycemia (glucose >250 mg/dL
2.
Ketosis,
3.
Acidemia (pH <7.3).
4.
Pain in abdomen
40.
Which of the following is not seen in cases of DKA
Increased amino acid levels
Decreased glycerol levels
Incresed ketone bodies
Decresed glucose uptake
41.
WHICH OF THE FOLLOWING IS NOT A KETONE
BODY
2.
Acetoacetate,
β-hydroxybutyrate.
1.
ACETIC ACID
1.
Acetone,
1.
42.
Which of the following is not seen in cases of DKA
Glucose 250-600
Sod. Bicarbonate >15 meq
SERUM Potassium -Normal to↑
Osmolality -300-320
43.
During management of DKA which of the electrolyte
is to be strictly monitored
Sodium
Potassium
Magnesium
Calcium
44. Approximate amount of water deficit in DKA
100ml/kg
200ml/kg
300ml/kg
400ml/kg