Diabetic Ketoacidosis Triage, Management, Treatment, Plan Questions & Answers Already Passed!!

Define Diabetic Ketoacidosis (DKA) - Answer-1. hyperglycemia 2. ketonemia 3. acidemia Definition of DKA - Answer-- glucose in excess of 300, usually more than 500 but less than 800 How do you manage a patient with hypoglycemia and confusion? - Answer-If awake and oriented and not a risk for aspiration - give oral glucose, need to have high protein meal to ensure continued glucose metabolism If not alert and disoriented IV glucose or IM glucagon Kussmaul respirations - Answer-- rapid, deep, sighing respiration, suggestive of DKA What are some early signs of DKA? - Answer-- tachycardia - diaphoresis - anxiety - can also see hyperactivity, seizures, psychotic behavior What are the EKG findings? - Answer-- serum K+ potassium is usually normal or high, but falls when treatment is given - Tall peak T waves = hyperkalemia - do not give more K+ - Early supplementation considered is T waves normal or small, U waves What are the initial steps in management of DKA with an altered mental status? - Answer-Airway patency, give O2- Rapid admin of isotonic crystalloid - dextrose - naloxone 2mg to avoid opioid intoxication - urine - coma scale - flow sheet What is hyperosmolar hyperglycemic state? or hyperosmolar coma? - Answer-- lack of insulin, hyper due to ketone production - neurologic deficit - mortality due to MI or cerebrovascular What is the electrolyte status? - Answer-- sodium deficit is usually present in DKA; falsely lowered due to hyperglycemia What is the equation for serum osmolality? - Answer-2 (Na) + glucose/ 18 + BUN /2.8 What is the most important part of the clinical management of DKA? - Answer-- Fluids IV Hemodynamically unstable: give 2L of .9 NaCL given @ rapid rate - If patient stabish - give 1L over 30 mins * reassess after 2L - Giving normal saline can lower glucose by 15-20% What is the normal range? - Answer-285-295 mOsm/L Significant hyperosmolarity exist in levels greater than 320What is your goal amount for decreasing glucose/hour? - Answer-- 100mg/Dl/Hr - After first hour administer insulin until acidosis and ketoemia are resolved - initial loading dose 0.1 unit/kg/ regular What the 3 major metabolic abnormalities considered in a diabetic patient? - Answer-- Hypoglycemia: low blood sugar - Diabetic ketone acidosis - Hyperosmolar, Hyperglycemic state