Diabetes2 Exam (THERAPEUTICS)
What is diabetic ketoacidosis?
A life threatening state resulting from a relative or absolute deficiency of insulin (mostly
in Type 1)
what is diabetic ketoacidosis a triad of?
• hyperglycemia
• ketosis
• anion gap metabolic acidosis
what is the pathophysiology of diabetic ketoacidosis?
Insulin deficit with increased levels of stress hormones (glucagon, cortisol, epi, growth
hormone) and a precipitating factor
what are the precipitating factors of diabetic ketoacidosis?
• Insulin deficiency
--> Undiagnosed DM 1
--> Non-compliance
• Stress - infection, illness, AMI, stroke
what are the results of insulin deficiency?
• hyperglycemia
• Glycogen Catabolism
• Glycogen Depletion
• Lipolysis
• Ketosis
What are the results of hyperglycemia?
• Polydipsia, polyuria, weight loss
• Volume depletion, Osmotic diuresis, Dehydration
• Electrolyte Depletion (K and Mag)
• Renal Hypoperfusion
• Hypotension and shock
what are the results of ketosis?
• Anion Gap Metabolic Acidosis
• Compensatory Alkalosis
• Hypotension
• Shock
what is the clinical course of DKA?
• hyperglycemia
• Polydipsia, polyuria, dehydration
• Anorexia, N/V, Abdominal Pain, Acidosis
• Kussmaul Breathing (compensatory alkalosis
• Altered Consciousness
• CV collapse
• Coma and Death
what is the diagnostic criteria of DKA?
, • BS >250
• pH <7.3 (low)
• Bicarb <15 (low)
• Ketonuria or ketonemia (normally absent)
what are the ways to treat DKA?
• IV REGULAR insulin
• IV Fluids
• IV Potassium supplementation
how do you treat DKA via IV REGULAR insulin?
• 0.1u/k bolus
• + 0.1u/kg/hr infusion*
*See potassium for warning
how do you treat DKA via IV Fluids?
IV Fluids (7-10% total body fluids)
• 0.9% NS if corrected Na+ <135
OR
• 0.45% NS is Corr. Na >135
how do you treat DKA via IV potassium supplementation?
• K+ will initially be elevated due to intracellular shift, once IV insulin is given K+ will
return to intracellular space and serum K+ will be dangerously low
• Serum K+ must be >3.3 before insulin is given
what are other ways DKA is treated besides IV REGULAR insulin, IV Fluids, IV
Potassium supplementation?
• Once blood glucose falls <250 replace dextrose but CONTINUE IV insulin until
ketones are undetectable (metabolism returns to normal)
• Administration of Bicarbonate not recommended for acidosis unless Ph<6.9
what is Hyperglycemic Hyperosmolar Syndrome (HHS)?
• A life-threatening emergency resulting from severe dehydration and hyperglycemia in
Type 2 diabetics
• Even minimal insulin production protects from ketosis
• Hyperglycemia becomes so severe that serum osmolarity elevates and severe
dehydration occurs as result of osmotic diuresis
what is the diagnostic criteria of Hyperglycemic Hyperosmolar Syndrome (HHS)?
• Blood Glucose >600 mg/dl
• pH >7.3
• Bicarb >18 mEq/L
• Serum Osmolarity >320 mOsmol/L
T or F: the precipitating factors of DKA are the same for HHS
true
how is HHS treated?
What is diabetic ketoacidosis?
A life threatening state resulting from a relative or absolute deficiency of insulin (mostly
in Type 1)
what is diabetic ketoacidosis a triad of?
• hyperglycemia
• ketosis
• anion gap metabolic acidosis
what is the pathophysiology of diabetic ketoacidosis?
Insulin deficit with increased levels of stress hormones (glucagon, cortisol, epi, growth
hormone) and a precipitating factor
what are the precipitating factors of diabetic ketoacidosis?
• Insulin deficiency
--> Undiagnosed DM 1
--> Non-compliance
• Stress - infection, illness, AMI, stroke
what are the results of insulin deficiency?
• hyperglycemia
• Glycogen Catabolism
• Glycogen Depletion
• Lipolysis
• Ketosis
What are the results of hyperglycemia?
• Polydipsia, polyuria, weight loss
• Volume depletion, Osmotic diuresis, Dehydration
• Electrolyte Depletion (K and Mag)
• Renal Hypoperfusion
• Hypotension and shock
what are the results of ketosis?
• Anion Gap Metabolic Acidosis
• Compensatory Alkalosis
• Hypotension
• Shock
what is the clinical course of DKA?
• hyperglycemia
• Polydipsia, polyuria, dehydration
• Anorexia, N/V, Abdominal Pain, Acidosis
• Kussmaul Breathing (compensatory alkalosis
• Altered Consciousness
• CV collapse
• Coma and Death
what is the diagnostic criteria of DKA?
, • BS >250
• pH <7.3 (low)
• Bicarb <15 (low)
• Ketonuria or ketonemia (normally absent)
what are the ways to treat DKA?
• IV REGULAR insulin
• IV Fluids
• IV Potassium supplementation
how do you treat DKA via IV REGULAR insulin?
• 0.1u/k bolus
• + 0.1u/kg/hr infusion*
*See potassium for warning
how do you treat DKA via IV Fluids?
IV Fluids (7-10% total body fluids)
• 0.9% NS if corrected Na+ <135
OR
• 0.45% NS is Corr. Na >135
how do you treat DKA via IV potassium supplementation?
• K+ will initially be elevated due to intracellular shift, once IV insulin is given K+ will
return to intracellular space and serum K+ will be dangerously low
• Serum K+ must be >3.3 before insulin is given
what are other ways DKA is treated besides IV REGULAR insulin, IV Fluids, IV
Potassium supplementation?
• Once blood glucose falls <250 replace dextrose but CONTINUE IV insulin until
ketones are undetectable (metabolism returns to normal)
• Administration of Bicarbonate not recommended for acidosis unless Ph<6.9
what is Hyperglycemic Hyperosmolar Syndrome (HHS)?
• A life-threatening emergency resulting from severe dehydration and hyperglycemia in
Type 2 diabetics
• Even minimal insulin production protects from ketosis
• Hyperglycemia becomes so severe that serum osmolarity elevates and severe
dehydration occurs as result of osmotic diuresis
what is the diagnostic criteria of Hyperglycemic Hyperosmolar Syndrome (HHS)?
• Blood Glucose >600 mg/dl
• pH >7.3
• Bicarb >18 mEq/L
• Serum Osmolarity >320 mOsmol/L
T or F: the precipitating factors of DKA are the same for HHS
true
how is HHS treated?
