Diabetic Ketoacidosis (DKA) Case Study Latest
update 2024 Diana Humphries, 45 years old
(Solved)
DKA - ANSWER: acute, major, life-threatening complication of diabetes
mostly occurs in patients with type I; rarely seen in type II
results from a relative or absolute lack of insulin combined with relative glucagon
increases
epidemiology - ANSWER: females > males
highest in whites
usually affects diabetics < 25 years old
estimated incidence is 1:2000
morbidity and mortality - ANSWER: rapid decrease from 7.96% twenty years ago to
0.67% today
mortality rate still high in developing countries
cerebral edema is main cause of mortality
thromboembolic events due to decreased perfusion of vital organs activating the
coagulation process
etiology - ANSWER: number one cause is infection (40%); insulin is needed with an
infection and the lack of insulin is what can cause DKA (missed insulin also a cause)
trauma
pregnancy
newly diagnosed or previously unknown diabetes
pathophysiology - ANSWER: lack of insulin causes serum glucose levels to rise
fatty acid levels are increased
beta-oxidation of free fatty acids leads to ketosis
ketonuria develops and if excretion of these products is inhibited (due to
dehydration), then plasma H+ concentration increases
pathophysiology - ANSWER: ketogenesis due to insulin deficiency leads to increased
serum levels of ketones anad ketonuria
acetoacetate, beta-hydroxybutyrate; ketone bodies produced by the liver, organic
acids that cause metabolic acidosis
respiration partially compensates; reduces pCO2, when pH < 7.2, deep rapid
respirations (Kussmaul breathing)
acetone; minor product of ketogenesis, can smell fruity on breath of ketoacidosis
patients
, hyperglycemia - ANSWER: eventually leads to dehydration whole body and
intracellular; whole body can lead to shock and intracellular can lead to impaired
consciousness
ketoacids - ANSWER: can cause anion gap metabolic acidosis
body has to compensate for anion gap metabolic acidosis; compensatory tachypnea
which can lead to dehydration
presentation - ANSWER: fruity or acetone breath, nausea/vomiting, dehydration,
polydipsia, polyuria, deep, rapid breathing (Kussmaul), lethargy, weakness, headache
diagnosis - ANSWER: hyperglycemia (> 250), acidosis (blood pH < or = 7.3), serum
bicarbonate (<15), ketosis, anion gap metabolic acidosis, fluid deficit 6 L or more
(deficits in serum sodium common)
anion gap - ANSWER: AG = Na - (Cl + HCO3)
measures unmeasured ions in your blood
normal range 10-14; patients presenting with DKA will have higher number
acidosis - ANSWER: pH < 7.35
condition of having too much H+
metabolic acidosis; decreased pH, decreased bicarb
respiratory acidosis; decreased pH, increased PaCO2
alkalosis - ANSWER: pH > 7.45
condition of having too little H+
metabolic alkalosis; increased pH, increased bicarb
respiratory alkalosis; increased pH, decreased PaCO2
metabolic acidosis compensation - ANSWER: respiratory compensation
quick response in minutes
acidosis means body has to lose acid or make more base
high acid content shifts Henderson-Hasselbach to right to increase the CO2
high CO2 reflects increased acid so lungs will increases respiration to remove CO2
which reduces acid
metabolic acidosis - ANSWER: decreased pH (< 7.35) and decreased bicarb (<22)
loss of bicarb
decreased acid excretion in the nephron
increased acid production
calculation of anion gap helps differentiate between etiologies (normal vs. elevated)
normal anion gap - ANSWER: hypokalemia; diarrhea, fistula drainage, early renal
failure or RTA, carbonic anhydrase inhibitors
hyperkalemia; hypoaldosteronism, HCl administration, drugs
elevated anion gap - ANSWER: Methanol intoxication
update 2024 Diana Humphries, 45 years old
(Solved)
DKA - ANSWER: acute, major, life-threatening complication of diabetes
mostly occurs in patients with type I; rarely seen in type II
results from a relative or absolute lack of insulin combined with relative glucagon
increases
epidemiology - ANSWER: females > males
highest in whites
usually affects diabetics < 25 years old
estimated incidence is 1:2000
morbidity and mortality - ANSWER: rapid decrease from 7.96% twenty years ago to
0.67% today
mortality rate still high in developing countries
cerebral edema is main cause of mortality
thromboembolic events due to decreased perfusion of vital organs activating the
coagulation process
etiology - ANSWER: number one cause is infection (40%); insulin is needed with an
infection and the lack of insulin is what can cause DKA (missed insulin also a cause)
trauma
pregnancy
newly diagnosed or previously unknown diabetes
pathophysiology - ANSWER: lack of insulin causes serum glucose levels to rise
fatty acid levels are increased
beta-oxidation of free fatty acids leads to ketosis
ketonuria develops and if excretion of these products is inhibited (due to
dehydration), then plasma H+ concentration increases
pathophysiology - ANSWER: ketogenesis due to insulin deficiency leads to increased
serum levels of ketones anad ketonuria
acetoacetate, beta-hydroxybutyrate; ketone bodies produced by the liver, organic
acids that cause metabolic acidosis
respiration partially compensates; reduces pCO2, when pH < 7.2, deep rapid
respirations (Kussmaul breathing)
acetone; minor product of ketogenesis, can smell fruity on breath of ketoacidosis
patients
, hyperglycemia - ANSWER: eventually leads to dehydration whole body and
intracellular; whole body can lead to shock and intracellular can lead to impaired
consciousness
ketoacids - ANSWER: can cause anion gap metabolic acidosis
body has to compensate for anion gap metabolic acidosis; compensatory tachypnea
which can lead to dehydration
presentation - ANSWER: fruity or acetone breath, nausea/vomiting, dehydration,
polydipsia, polyuria, deep, rapid breathing (Kussmaul), lethargy, weakness, headache
diagnosis - ANSWER: hyperglycemia (> 250), acidosis (blood pH < or = 7.3), serum
bicarbonate (<15), ketosis, anion gap metabolic acidosis, fluid deficit 6 L or more
(deficits in serum sodium common)
anion gap - ANSWER: AG = Na - (Cl + HCO3)
measures unmeasured ions in your blood
normal range 10-14; patients presenting with DKA will have higher number
acidosis - ANSWER: pH < 7.35
condition of having too much H+
metabolic acidosis; decreased pH, decreased bicarb
respiratory acidosis; decreased pH, increased PaCO2
alkalosis - ANSWER: pH > 7.45
condition of having too little H+
metabolic alkalosis; increased pH, increased bicarb
respiratory alkalosis; increased pH, decreased PaCO2
metabolic acidosis compensation - ANSWER: respiratory compensation
quick response in minutes
acidosis means body has to lose acid or make more base
high acid content shifts Henderson-Hasselbach to right to increase the CO2
high CO2 reflects increased acid so lungs will increases respiration to remove CO2
which reduces acid
metabolic acidosis - ANSWER: decreased pH (< 7.35) and decreased bicarb (<22)
loss of bicarb
decreased acid excretion in the nephron
increased acid production
calculation of anion gap helps differentiate between etiologies (normal vs. elevated)
normal anion gap - ANSWER: hypokalemia; diarrhea, fistula drainage, early renal
failure or RTA, carbonic anhydrase inhibitors
hyperkalemia; hypoaldosteronism, HCl administration, drugs
elevated anion gap - ANSWER: Methanol intoxication
