Dr. Kirkpatrick presented a case of a 64 yo M w/ generalized malaise, nausea, and vomiting.
He has lost 60 lbs over the last 6 months. No PMH as he hasn't seen a doctor in >40 years.
His initial labs showed a well-compensated pure AGMA (128- (89+10)) and a glucose of 490, as well as ketonuria and an A1C of 16.5%. He was Dx'd and treated for DKA.
What is it?
Lack of sufficient insulin to internalize glucose for utilization. Insufficient insulin to ward of lipolysis and beta hydroxylation -> ketone body formation in order to supply vital organs with energy.
Causes: med non-compliance, infection, MI, pancreatitis, surgery/trauma, etc.
Sxs:
Nausea/vomiting
Anorexia
Polyuria, polydipsia
Abdominal pain
± AMS
Kussmaul respirations
Acetone odor on pt’s breath
Lab Findings: (diagnostic criteria 1-3)
1. Blood glucose level > 250 mg/dL (usucally)
2. Metabolic acidosis*
a.Bicarb < 15 mEq/L
b. pH < 7.3
3. Ketosis (in urine: Ketonuria, or in blood: ketonemia)
4. Hyperkalemia (body has absolute hypOkalemia however)
5. Hyponatremia (usually PSEUDOhyponatremia because elevated glucose falsely lowers sodium)
*Anion gap present due to ketone presence. Concurrent NAGMA, Metabolic alkylosis can also be present. Respiratory compensation is hyperventilation.
Compared w/ HHS:
Pathogenesis of DKA:
DKA Treatment Plan Overview
1.Volume repletion
2.Reversal of metabolic consequences of insulin insufficiency
3.Correction of electrolyte & acid-base imbalances
4.Recognition and treatment of precipitating cause
5.Avoidance of complications...
Rare DKA Complications
1. ARDS
2. Cerebral Edema
a. during therapy, in young people
b. Presentation:
- Severe headache
- Incontinence
- Change in arousal/behavior
- Pupillary changes
- Seizures
- Bradycardia
c. Rx: IV Mannitol 1-2 g/kg
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