0071643192.pdf

A precipitating factor usually initiates this cascade of events:

■ Lack of insulin
■ Infection
■ Urinary tract infection
■ Pneumonia
■ Acute myocardial infarction or CVA
■ Trauma or surgery
■ Pregnancy
■ Hyperthyroidism
■ Pancreatitis
■ Alcohol or illicit drug use
■ Steroids
■ Pulmonary embolism

SYMPTOMS

■ Patients usually present with a history of one of the precipitating factors,
but may also complain of:
■ Thirst
■ Nausea/vomiting
■ Abdominal pain
■ Agitation or altered mental status

EXAM

■ Elevated glucose
■ Dehydration
■ Tachycardia
■ Deep and rapid breathing (Kussmaul respirations)
■ Hypotension
■ Acidosis
■ Pan electrolytes depletion, particularly potassium

DIFFERENTIAL

■ Hyperosmolar nonketotic coma
■ Other acidosis (eg, alcoholic ketoacidos, lactic acidosis)

DIAGNOSIS ANDCAUSES

■ Patients presenting with suspected DKA need a thorough evaluation.
■ Bedside glucose will indicate level of hyperglycemia.
■ Urine dip or urinalysis
■ Ketones (acetoacetate, β-hydroxybutyrate, and acetone)
■ A positive nitroprusside tests is consistent with DKA but only tests for
acetoacetate. a-Hydroxybutyrate is not measured with the nitroprus-
side test and ketone tests may be normal in patients with DKA.
■ Glucose usually >350 mg/dL unless recently used insulin
■ ABG and bicarbonate indicate level of acidosis (pH <7.30).
■ CBC is a marker for infectious etiology.
■ Individual serum ketones, which may be missed on urinalysis or serum
ketone level
■ Electrolytes including magnesium, calcium, and phosphorus
■ BUN/creatinine: Indicator of renal function and dehydration
■ Chest X-ray and urinalysis to look for signs of infection
■ ECG and cardiac enzymes if appropriate for patient

ENDOCRINE, METABOLIC, FLUID, AND

ELECTROLYTE DISORDERS

Common causes of

DKA:

Insulin (lack of)

Infection

Ischemia (MI, CVA)

Illicit drug use (cocaine)

Hyperglycemia depresses

serum sodium by dilution. To

correctly interpret the sodium

level, add 1.6 mEq/L for each

100 mg/dL of glucose above

100 mg/dL.