Diabetic ketoacidosis DKA

• Facts:
  Complication seen in patients with DM I
  Hyperglycemia-induced crisis
  Lack of available glucose, leads to breaking down of FAs
  Production of ketone bodies
  
• History / PE:
  H/O recent URI
  Mild leukocytosis
  Kussmaul respirations (rapid, deep breathing)
  Polyuria
  Dehydration
  Fruity, acetone breath odor
  Decreased level of consciousness
  Diffuse abdominal pain
• Diagnosis:
  Hyperglycemia (glucose > 250 mg/dL)
  Metabolic acidosis (pH<7.3 or bicarbonate < 15-20mmol/L)
  Plasma ketones
  Paradoxical hyperkalemia (extracellular K+ shift)
• Treatment:
  Normal (0.9%) saline (restore intravascular volume)
  Regular insulin (correct hyperglycemia)
  Potassium (correct electrolytes)
  Treat precipitating factors (eg. antibiotics )
  Bicarbonate (if pH < 7.0)
  
  ***Best indicator of metabolic recovery is arterial ph or anion gap
• Notes:
  Hyperosmolar hyperglycemic state (HHS) in DM II
  
• Associated With:
  Infections
  MI
  Trauma
  ETOH