Hyperglycemia, osmotic diuresis, serum hyperosmolarity, and metabolic acidosis result in severe electrolyte disturbances. The most characteristic disturbance is total body potassium loss. This loss is not mirrored in serum potassium levels, which may be low, within the reference range, or even high.
Herein, what acid base disturbances commonly occur in DKA?
Acidosis in DKA is due to the overproduction of β-hydroxybutyric acid and acetoacetic acid. At physiological pH, these 2 ketoacids dissociate completely, and the excess hydrogen ions bind the bicarbonate, resulting in decreased serum bicarbonate levels.
Similarly, what electrolytes are monitored in the acute stage of DKA Why? Potassium, bicarbonate, and phosphate therapy Serum potassium should be closely monitored during DKA treatment. Insulin administration and correction of acidemia and hyperosmolality drive potassium intracellularly, resulting in hypokalemia that may lead to arrhythmias and cardiac arrest.
Accordingly, what electrolytes should be monitored in DKA?
Blood glucose should be evaluated every one to two hours until the patient is stable, and the blood urea nitrogen, serum creatinine, sodium, potassium, and bicarbonate levels should be monitored every two to six hours depending on the severity of DKA.
Why do you get hyperkalemia in DKA?
One example of potassium shift causing hyperkalemia is diabetic ketoacidosis. The acidosis and high glucose levels in the blood work together to cause fluid and potassium to move out of the cells into the blood circulation.
17 Related Question Answers Found
How do I know if I have DKA?
You can check for ketones using a urine test or blood test, which are available at most pharmacies. A simple urine test that involves peeing on a Ketostix or dipping the Ketostix into a cup of urine, and observing the color change on the strip. A blood test can be done with special ketone test strips.
Is potassium high or low in DKA?
Potassium levels can fluctuate severely during the treatment of DKA, because insulin decreases potassium levels in the blood by redistributing it into cells via increased sodium-potassium pump activity. A large part of the shifted extracellular potassium would have been lost in urine because of osmotic diuresis.
How is hypovolemia corrected?
Hypovolemia shock with hypotension should be treated by rapid restoration of intravascular volume using isotonic crystalloid solutions such as 0.9% saline. In this scenario small-volume resuscitation with hypertonic saline (5 ml/kg 3% saline) may be prudent to avoid large volumes of fluid replacement.
What is the difference between DKA and HHS?
Although both conditions can occur at any age, diabetic ketoacidosis typically develops in younger patients, less than 45 years, who have little or no endogenous insulin production, whereas HHS usually occurs in much older non-insulin-dependent patients (who are often greater than 60 years old).
Why is chloride low in diabetic ketoacidosis?
CONTEXT AND OBJECTIVE: Diabetic ketoacidosis (DKA) is associated with a metabolic alkalosis, which is thought to be due to vomiting. However, alkalosis can occur in DKA without vomiting. Sodium-corrected chloride level and the chloride/sodium ratio were significantly lower in the DKA group than in the pre-DKA group.
Why does DKA cause tachycardia?
Diabetic Ketoacidosis DKA typically presents with hyperglycemia, arterial pH <7.3, serum ketones, and a high anion gap acidosis. Hyperglycemia can lead to osmotic diuresis and tachycardia, while volume depletion with peripheral vasodilation can result in hypotension.
Why do you get abdominal pain in DKA?
Many mechanisms have been suggested to underlie the abdominal symptoms in DKA, namely acute hyperglycemia mediated impaired gastrointestinal motility (esophageal, gastric and gallbladder), rapid expansion of the hepatic capsule, and mesenteric ischemia precipitated by volume depletion.
What is hyperosmolar hyperglycemic state?
Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Onset is typically over days to weeks.
What IV fluids do you give for DKA?
FLUID REPLACEMENT The initial priority in the treatment of diabetic ketoacidosis is the restoration of extra-cellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution.
How long is recovery from DKA?
Expected Duration Symptoms of diabetic ketoacidosis can develop over a period of a few hours, and treatment results in rapid recovery. Commonly, people who develop ketoacidosis will remain in the hospital for one to three days.
Why do we give dextrose in DKA?
When the serum glucose reaches 200 mg/dL in a patient with diabetic ketoacidosis (DKA), IV dextrose is added to avoid the development of cerebral edema. If a patient has euglycemic DKA, they will still need insulin treatment to resolve the ketoacidosis. Without dextrose, they will develop hypoglycemia.
What insulin do you give for DKA?
Only short-acting insulin is used for correction of hyperglycemia. Subcutaneous absorption of insulin is reduced in DKA because of dehydration; therefore, using intravenous routes is preferable. SC use of the fast-acting insulin analog (lispro) has been tried in pediatric DKA (0.15 U/kg q2h).
How long does it take for DKA to set in?
Within 24-48 hours they’ll be in DKA. Beyond that, mortal outcomes would likely occur within days to perhaps a week or two.
How do you fix DKA at home?
How can you care for yourself at home? Take your insulin and diabetes medicines. Drink extra fluids to prevent dehydration. Try to eat as you normally do, with a focus on healthy food choices. Check your blood sugar at least every 3 to 4 hours. Check your temperature and pulse often.
When should DKA protocol be stopped?
Continue insulin infusion until blood-ketone concentration is below 0.3 mmol/litre, blood pH is above 7.3 and the patient is able to eat and drink; ideally give subcutaneous fast-acting insulin and a meal, and stop the insulin infusion 1 hour later.
What lab values indicate DKA?
While definitions vary, mild DKA can be categorized by a pH level of 7.25-7.3 and a serum bicarbonate level between 15-18 mEq/L; moderate DKA can be categorized by a pH between 7.0-7.24 and a serum bicarbonate level of 10 to less than 15 mEq/L; and severe DKA has a pH less than 7.0 and bicarbonate less than 10 mEq/L.
Can you have DKA and HHS at the same time?
Both DKA and HHS are characterized by hyperglycemia and absolute or relative insulinopenia. Clinically, they differ by the severity of dehydration, ketosis and metabolic acidosis (11). DKA most often occurs in patients with type 1 diabetes mellitus (T1DM).