PHR 966 Block 3 Exam Study Set With
Complete Solution
What are some differential diagnoses for DKA? - ANSWER - Dehydration
- Anemia
- Sepsis
- Hyponatremia
- Intentional or unintentional overdose
- HHS
What are rapid, deep, constant breaths that are generally indicative of metabolic
acidosis? - ANSWER Kussmaul respirations
What is the most likely diagnosis for a patient presenting with some or all of the
following?
- dehydration
- tachycardia
- kussmaul respirations
- fruity breath
- hyperkalemia
- dilutional hyponatremia
- polyuria
- nausea/vomiting/abdominal pain
- altered mental status
- dry mucous membranes - ANSWER DKA
What are some common causes or precipitating factors of DKA? - ANSWER - Infection
- Medication non-adherence and medications
- Pancreatitis
,- New onset
- Cerebrovascular accident
- Myocardial infarction
What medications can cause DKA? - ANSWER - Steroids
- Thiazides
- Sympathomimetics
Explain some pathophysiologic effects of insulin deficiency - ANSWER - Increased
lipolysis (breaking down adipocytes)
- Ketogenesis
- Ketoacidosis
- Increased gluconeogenesis (more glucose)
- Increased glycogenolysis
- Decreased glucose utilization
- Increased beta-oxidation (ketoacid build up)
What are the insulin dependent transporters found in skeletal muscle, cardiac muscle,
and adipocytes? - ANSWER GLUT4
What effects does DKA have on electrolytes? - ANSWER - Hyperkalemia (due to
compensation)
- Hyperglycemia
- Dilutional hyponatremia
- Phosphate depletion (limits ATP production)
What is the most common precipitating factor for HHS? - ANSWER Dehydration
What disorder occurs more commonly in patients with T2DM, has more severe
hyperglycemia, higher osmolality, and small ketones with variable anion gap? - ANSWER
HHS
What are the three key treatments to DKA? - ANSWER - Fluids (mainstay of treatment)
- Insulin
- Potassium
What are other potential treatment options for DKA in addition to fluid, insulin, and
,potassium? - ANSWER - Dextrose
- Bicarbonate
How do we administer IV fluids to DKA patients? - ANSWER - 15 to 20mL/kg STAT bolus
of NaCl or LR
- Maintenance fluids based on sodium levels
How are maintenance fluids administered for DKA patients with sodium <135 mmol/L? -
ANSWER 250 mL/hr NaCl or LR (LR usually preferred as chloride can worsen DKA)
How are maintenance fluids administered for DKA patients with sodium 135 mmol/L or
higher? - ANSWER 1/2NS at 250 mL/hr
What electrolyte must be corrected prior to administering insulin in patients with DKA
and what must it be? - ANSWER Potassium: >3.3 mEq/L
What is the infusion rate for insulin in patients with DKA? - ANSWER 0.1 to 0.14
units/kg/hr
What must be administered with insulin in patients with DKA to ensure that insulin
infusions can be continued to correct the DKA, which can take 10 to 12 hours? -
ANSWER Dextrose when glucose reaches 250 mg/dL or less
How long does it take to normalize glucose and resolve DKA? - ANSWER - 4 to 8 hours to
normalize glucose
- 10 to 12 hours to resolve DKA
When should sodium bicarb be considered in DKA patients? - ANSWER Severe acidosis
(pH <6.9)
What are some possible risks of sodium bicarb administration? - ANSWER -
Hypokalemia
- Increased tissue oxygen update
- Cerebral edema
- Development of paradoxical CNS acidosis
- CO2 build up
What are our blood glucose goals in the treatment of DKA? - ANSWER - Decrease by 50
to 100 mg/dL/hr
- Target BG = 150-250 mg/dL
What are the criteria to consider DKA resolved? - ANSWER BG <250 mg/dL + two of the
following:
, - anion gap 12 mEq/L or mmol/L or less
- pH >7.3
- Bicarb 15 mEq/L or mmol/L or higher
What is DKA in the presence of blood glucose <250 mg/dL? - ANSWER Euglycemic
diabetic ketoacidosis
How is euglycemic DKA generally characterized (labs)? - ANSWER - Ketones
- Insulin deficiency
- Anion gap metabolic acidosis
What are some causes of euglycemic DKA? - ANSWER - Starvation
- Vomiting
- Depression
- Pregnancy
- Glycogen storage disorders
- Cirrhosis
- Salicylate overdose
- Methanol ingestion
- Lactic acidosis
- Pancreatitis
- Sepsis
- Renal tubular acidosis
What medications did we not realize initially caused euglycemic DKA due to a novel
mechanism that results in decreased sodium and glucose through the urine, inducing a
relative insulin deficiency? - ANSWER SGLT2 inhibitors
How do SGLT2 inhibitors cause DKA? - ANSWER - Lower blood glucose (reducing
insulin secretion)
- Increase lipolysis (FFA oxidation and ketosis)
How is euglycemic DKA treated? - ANSWER - Insulin
- Fluids with dextrose
- Discontinue SGLT2 inhibitors
Complete Solution
What are some differential diagnoses for DKA? - ANSWER - Dehydration
- Anemia
- Sepsis
- Hyponatremia
- Intentional or unintentional overdose
- HHS
What are rapid, deep, constant breaths that are generally indicative of metabolic
acidosis? - ANSWER Kussmaul respirations
What is the most likely diagnosis for a patient presenting with some or all of the
following?
- dehydration
- tachycardia
- kussmaul respirations
- fruity breath
- hyperkalemia
- dilutional hyponatremia
- polyuria
- nausea/vomiting/abdominal pain
- altered mental status
- dry mucous membranes - ANSWER DKA
What are some common causes or precipitating factors of DKA? - ANSWER - Infection
- Medication non-adherence and medications
- Pancreatitis
,- New onset
- Cerebrovascular accident
- Myocardial infarction
What medications can cause DKA? - ANSWER - Steroids
- Thiazides
- Sympathomimetics
Explain some pathophysiologic effects of insulin deficiency - ANSWER - Increased
lipolysis (breaking down adipocytes)
- Ketogenesis
- Ketoacidosis
- Increased gluconeogenesis (more glucose)
- Increased glycogenolysis
- Decreased glucose utilization
- Increased beta-oxidation (ketoacid build up)
What are the insulin dependent transporters found in skeletal muscle, cardiac muscle,
and adipocytes? - ANSWER GLUT4
What effects does DKA have on electrolytes? - ANSWER - Hyperkalemia (due to
compensation)
- Hyperglycemia
- Dilutional hyponatremia
- Phosphate depletion (limits ATP production)
What is the most common precipitating factor for HHS? - ANSWER Dehydration
What disorder occurs more commonly in patients with T2DM, has more severe
hyperglycemia, higher osmolality, and small ketones with variable anion gap? - ANSWER
HHS
What are the three key treatments to DKA? - ANSWER - Fluids (mainstay of treatment)
- Insulin
- Potassium
What are other potential treatment options for DKA in addition to fluid, insulin, and
,potassium? - ANSWER - Dextrose
- Bicarbonate
How do we administer IV fluids to DKA patients? - ANSWER - 15 to 20mL/kg STAT bolus
of NaCl or LR
- Maintenance fluids based on sodium levels
How are maintenance fluids administered for DKA patients with sodium <135 mmol/L? -
ANSWER 250 mL/hr NaCl or LR (LR usually preferred as chloride can worsen DKA)
How are maintenance fluids administered for DKA patients with sodium 135 mmol/L or
higher? - ANSWER 1/2NS at 250 mL/hr
What electrolyte must be corrected prior to administering insulin in patients with DKA
and what must it be? - ANSWER Potassium: >3.3 mEq/L
What is the infusion rate for insulin in patients with DKA? - ANSWER 0.1 to 0.14
units/kg/hr
What must be administered with insulin in patients with DKA to ensure that insulin
infusions can be continued to correct the DKA, which can take 10 to 12 hours? -
ANSWER Dextrose when glucose reaches 250 mg/dL or less
How long does it take to normalize glucose and resolve DKA? - ANSWER - 4 to 8 hours to
normalize glucose
- 10 to 12 hours to resolve DKA
When should sodium bicarb be considered in DKA patients? - ANSWER Severe acidosis
(pH <6.9)
What are some possible risks of sodium bicarb administration? - ANSWER -
Hypokalemia
- Increased tissue oxygen update
- Cerebral edema
- Development of paradoxical CNS acidosis
- CO2 build up
What are our blood glucose goals in the treatment of DKA? - ANSWER - Decrease by 50
to 100 mg/dL/hr
- Target BG = 150-250 mg/dL
What are the criteria to consider DKA resolved? - ANSWER BG <250 mg/dL + two of the
following:
, - anion gap 12 mEq/L or mmol/L or less
- pH >7.3
- Bicarb 15 mEq/L or mmol/L or higher
What is DKA in the presence of blood glucose <250 mg/dL? - ANSWER Euglycemic
diabetic ketoacidosis
How is euglycemic DKA generally characterized (labs)? - ANSWER - Ketones
- Insulin deficiency
- Anion gap metabolic acidosis
What are some causes of euglycemic DKA? - ANSWER - Starvation
- Vomiting
- Depression
- Pregnancy
- Glycogen storage disorders
- Cirrhosis
- Salicylate overdose
- Methanol ingestion
- Lactic acidosis
- Pancreatitis
- Sepsis
- Renal tubular acidosis
What medications did we not realize initially caused euglycemic DKA due to a novel
mechanism that results in decreased sodium and glucose through the urine, inducing a
relative insulin deficiency? - ANSWER SGLT2 inhibitors
How do SGLT2 inhibitors cause DKA? - ANSWER - Lower blood glucose (reducing
insulin secretion)
- Increase lipolysis (FFA oxidation and ketosis)
How is euglycemic DKA treated? - ANSWER - Insulin
- Fluids with dextrose
- Discontinue SGLT2 inhibitors
