DKA

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Author:
jjennings1
ID:
199427
Filename:
DKA
Updated:
2013-02-10 18:07:49
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DKA
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DKA
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  1. In DKA what is decreased and what is increased?
    • Insulin deficiency (decreased)
    • Increased levels of:
    • catecholamines
    • cortisol 
    • glucagon
    • growth hormone
  2. During DKA the body breaks down ____ for energy?
    Fat and protein (catabolism)-the breakdown of fats leads to the production of fatty acids.  These undergo transformation to keto acids in the liver.
  3. During DKA pH _____  and _____ are present in the urine, thus sharply increasing _______.
    During DKA pH falls (6.8-7.3) and ketone bodies are present in the urine, thus sharply increasing osmotic fluid loss.
  4. Metabolic acidosis ensues as the _______ decreases, and DKA results.  In response to the metabolic acidosis, extracellular _____ are exchanged for intracellular _________.  
    bicarbonate concentration decreases

    extracellular hydrogen ions are exchanged for intracellular K ions.  
  5. Respiratory compensation for the metabolic acidosis in the form of deep, labored respirations that are fruity (________), results in lowered _____ values (_______)
    Kussmaul respirations- deep labored fruity

    lowered Pco2 values (compensatory respiratory alkalosis.  
  6. To be diagnosed with DKA, glucose levels are_______
    >300 mg/dL
  7. ______ is released during stressful situations.
    cortisol
  8. During DKA fluids become _______.
    hyperosmotic (fluids leave cells and enter the vascular system)
  9. Renal response during DKA
    Kidneys increase urine output (K+, Na)
  10. Potassium levels in DKA
    Initially they are high, then the level falls.
  11. In Kussmal respirations _______ is longer than ______.
    expiration is longer than inspiration in an attempt to blow off excess CO2, fruity breath
  12. In patients with DKA they are NPO until their blood glucose levels are _____
    >250
  13. Fluids to give pts with DKA
    -1st hour
    -2nd hour
    • 1st hour - give 1L 0.9% NS, this keeps fluids in the vascular system
    • 2.d hour - 0.45% NS (750 mL/hr), this is a hypertonic solution, osmolality is higher in the vascular system pushes fluids into cells
    • ***When blood glucose levels reach 250 mg/dL, give 5% dextrose in 0.45% NS, this prevents hypoglycemia and cerebral edema

    MUST BE ON A PUMP!
  14. In DKA we want serum glucose to drecrease by ___ to____ per hour.
    • 50-75 mg/dL/hr
    • slowly over 6-8 hours until back to normal
    • may have to increase or decrease rate
  15. What is the most common precipitator for development of DKA?
    infection
  16. S&S of DKA
    • polyuria, polyphagia, polydipsia
    • weight loss
    • vomiting & abd pain
    • dehydration
    • weakness
    • altered mental status
    • shock
    • coma
  17. How are keto acids formed?
    Fatty acids undergo transfomation into keto acids in the liver.

    fatty acids result from metabolism of fats
  18. Keto acids cause pH to _____
    Fall (6.8-7.3)
  19. In DKA you will see an increase in ____ and a decrease in _____

    IONS
    increase in hydrogen and decrease in bicarb

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