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Flashcards in Glucose Disorders Deck (22)
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0
Q

DKA Triad

A

Acidosis
Ketosis
Hyperglycemia

1
Q

Prognosis worsened by

A

Age extremes
Coma
Hypotension

3
Q

Hyperglycemia results from

A

– increased gluconeogenesis
– accelerated glycogenolysis
– impaired glucose utilization

3
Q

Two main precipitating factors of HHS

A

Infxn

DC or decrease insulin therapy

4
Q

Ketosis results from

A

Insulin deficiency and increased cortisol, catecholamines, and growth hormone leading to increased fatty acid oxidation by the liver

6
Q

Bicarb buffer most important b/c…

A

– More bicarbonate in the ECF than any other
buffer
– Unlimited supply of CO2
– Degree of ECF acidity can be regulated by changing HCO3- and/or pCO2

7
Q

DKA Clinical Presentation

A

Rapidly develops, usually over 24 hr period w/N/V and abdominal pain, thirst, and polyuria
PE reveals Physical Exam Kussmaul respirations, Fruity breath, Tachycardia, Dry mucous membranes and Poor skin turgor

8
Q

HHS Clinical Presentation

A

HHS typically evolves over several days to weeks w/Polyuria, polydipsia, Vomiting, Weakness and Mental status changes

9
Q

Avg K+ deficit with DKA vs HHS

A

DKA - 3 to 5

HHS - 5 to 15

10
Q

Mild DKA

A

pH 7.25-7.30

Serum Bicarb 15-18

11
Q

Mod DKA

A

pH 7 to 7.24

Serum Bicarb 10-14

12
Q

Severe DKA

A

pH less than 7

Serum Bicarb less than 10

13
Q

DKA vs HHS glucose levels

A

DKA >250

HHS >600

14
Q

DKA vs HHS pH levels

A

DKA below 7.3

HHS >7.3

15
Q

Serum and Urine Ketones in DKA vs HHS

A

DKA will have high ketones (dKa)

16
Q

DKA vs HHS anion gap

A

DKA >12

HHS is variable

17
Q

Which has more severe dehydration, DKA or HHS?

A

HHS > DKA

18
Q

DKA vs HHS serum osmolality

A

DKA less than 320

HHS > 320

19
Q

DKA vs HHS serum bicarb

A

DKA less than 18

HHS > 18

20
Q

DKA and HHS initial Tx

A

Aimed at volume expansion and restoration of renal perfusion
– Initial fluid choice is 0.9% NaCl
– 1-1.5 L over first 1 hour
– Subsequent fluid choice depends on hydration status, urine output and electrolytes

When BG reaches 200 mg/dL (DKA) or 300 mg/dL (HHS), switch fluid to D5W + 0.45% NaCl at 250-500 mL/hr

Fluid replacement should correct estimated deficits within the first 24 hrs

21
Q

When do you switch to D5W + 0.45% NaCl

A

When BG reaches 200 for DKA or 300 for HHS

22
Q

Other Tx in DKA and HHS

A
  • Insulin IV (switch SQ once under control w/1-2 hr overlap)

– Hypokalemia is common in the treatment of DKA
and HHS
– 20-30 mEq K+ should be added to each liter of fluid once serum K+ concentration < 5.2 mEq/L (chloride and phosphate salts preferred)
– Insulin therapy should be delayed in patients with a serum K+ concentration < 3.3 mEq/L to avoid severe hypokalemia