Medical Field 💝

🔴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.

🔷Signs and symptoms:-

The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. 🔷The following are other signs and symptoms of DKA:-

Malaise, generalized weakness, and fatigability
Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia
Rapid weight loss in patients newly diagnosed with type 1 diabetes
History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump
Decreased perspiration
Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis
🔶Signs and symptoms of DKA associated with possible intercurrent infection are as follows:-

Fever
Coughing
Chills
Chest pain
Dyspnea
Arthralgia

🔶Diagnosis:-
On examination, general findings of DKA may include the following:-

🔹Ill appearance
🔹Dry skin
🔹Labored respiration
🔹Dry mucous membranes
🔹Decreased skin turgor
🔹Decreased reflexes
🔹Characteristic acetone (ketotic) breath odor
🔹Tachycardia
🔹Hypotension
🔹Tachypnea
🔹Hypothermia
🔹In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess.

🔶Testing:-

Initial and repeat laboratory studies for patients with DKA include the following:-

🔹Serum glucose levels
🔹Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus)
🔹Bicarbonate levels
🔹Amylase and lipase levels
🔹Urine dipstick
🔹Ketone levels
🔹Serum or capillary beta-hydroxybutyrate levels
🔹ABG measurements
🔹CBC count
🔹BUN and creatinine levels
🔹Urine and blood cultures if intercurrent infection is suspected
ECG (or telemetry in patients with comorbidities)
🔹Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels.

🔶Imaging tests:-

Radiologic studies that may be helpful in patients with DKA include the following:-

🔹Chest radiography: To rule out pulmonary infection such as pneumonia
🔹Head CT scanning: To detect early cerebral edema; use low threshold in children with DKA and altered mental status
🔹Head MRI: To detect early cerebral edema (order only if altered consciousness is present [1] )
Do not delay administration of hypertonic saline or mannitol in those pediatric cases where cerebral edema is suspected, as many changes may be seen late on head imaging.

🔶Management Goals:-

Treatment of ketoacidosis should aim for the following:-

🔹Fluid resuscitation
🔹Reversal of the acidosis and ketosis
🔹Reduction in the plasma glucose concentration to normal
🔹Replenishment of electrolyte and volume losses
🔹Identification the underlying cause
Pharmacotherapy

🔹Regular and analog human insulins are used for correction of hyperglycemia, unless bovine or pork insulin is the only available insulin.

🔶Medications used in the management of DKA include the following:-

🔹Rapid-acting insulins (eg, insulin aspart, insulin glulisine, insulin lispro)
🔹Short-acting insulins (eg, regular insulin)
🔹Electrolyte supplements (eg, potassium chloride)
🔹Alkalinizing agents (eg, sodium bicarbonate)......

2.18K viewsDr.Honest Heart, 17:13