Diabetic Ketoacidosis.ppt

Diabetic Ketoacidosis Michele Ritter, M.D. Argy Resident – February, 2007 Diabetic Ketoacidosis (DKA) A state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism, including production of serum acetone. Can occur in both Type I Diabetes and Type II Diabetes In type II diabetics with insulin deficiency/dependence The presenting symptom for ~ 25% of Type I Diabetics. Hyperosmolar Hyperglycemic State (HHS) An acute metabolic complication of diabetes mellitus characterized by impaired mental status and elevated plasma osmolality in a patient with hyperglycemia. Occurs predominately in Type II Diabetics A few reports of cases in type I diabetics. The presenting symptom for 30-40% of Type II diabetics. Diagnostic Criteria for DKA and HHS Causes of DKA/HHS Stressful precipitating event that results in increased catecholamines, cortisol, glucagon. Infection (pneumonia, UTI) Alcohol, drugs Stroke Myocardial Infarction Pancreatitis Trauma Medications (steroids, thiazide diuretics) Non-compliance with insulin Symptoms of DKA/HHS Polyuria Polydypsia Blurred vision Nausea/Vomiting Abdominal Pain Fatigue Confusion Obtundation Physical Examination in DKA/HHS Hypotension, tachycardia Kussmaul breathing (deep, labored breaths) Fruity odor to breath (due to acetone) Dry mucus membranes Confusion Abdominal tenderness Diagnostic Studies in DKA/HHS Chemistry ? Glucose ? Bicarbonate Anion gap = (Na+) – (Cl- + HCO3-) Frequently seen: ? BUN/creatinine (dehydration) ? potassium ? sodium Pseudohyponatremia: to correct, add 1.6 mEq of sodium to every 100mg/dL of glucose above normal Serum acetones Positive in DKA; Possibly small in HNS Urinalysis Ketones (for DKA); leukocyte esterase, WBC (for UTI) CBC Leukocytosis (possible infection) Amylase/Lipase To evaluate for pancreatitis BUT, DKA by itself can also increase them! EKG Evaluate for possible MI Treatment of DKA