Term
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Definition
| 1/4 of hospital admissions for DM; occurs predominantly in type 1 though may occur in type 2; mortality less than 5% |
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Term
|
Definition
| decrease hepatic glucose uptake |
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Term
| osmotic diuresis contributes to urinary loss and total body depletion |
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Definition
| of phosphorous, calcium, magnesium |
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Term
|
Definition
| hyperglycemia, increased osmotic load, patients initially compensate by increasing their fluid intake, initially polyuria and polydipsia are only symptoms until ketonemia and acidosis develop... |
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Term
| If suspect DKA want immediately: |
|
Definition
| blood glucose; urine dipstick; ECG; venous blood gas; normal saline IV drip |
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Term
| elevated serum eta-hydroxybutyrate and acetoacetate cause acidosis and ketonuria; elevated serum ketones may lead to a wide-anion gap metabolic acidosis; metabolic acidosis may be worsened by vomiting |
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Definition
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Term
|
Definition
| underlying rhythm is sinus tachycardia; changes of hypo/hyperkalemia; transient changes due to rapidly changing metabolic status; evaluate for ischemia because MI may precipitate DKA |
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Term
|
Definition
| volume repletion, reversal of metabolic consequences of insulin insufficiency, correction of electrolyte and acid-base imbalances, recognition and treatment of precipitating causes, avoidance of complications |
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|
Term
| single most important step in treatment |
|
Definition
| rapid fluid administration |
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|
Term
| monitor until recovery is well established |
|
Definition
| glucose, potassium and anion gap, vital signs, level of consciousness, volume input/output |
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Term
|
Definition
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Term
|
Definition
| within first 30 minutes of presentation |
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Term
|
Definition
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Add D5 to solution when glucose level: |
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Definition
|
|
Term
| Change to hypotonic 1/2 NS or D5 1/2 NS |
|
Definition
| if glucose below 300 mg/dL after initially using NS |
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|
Term
| If no extreme volume depletion |
|
Definition
| may manage with 500 ml/hr for 4 years |
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Term
|
Definition
| recommended dose is 0.1 unit/kg/hr |
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|
Term
|
Definition
|
|
Term
| initial hypokalemia indicates severe total-body potassium depletion |
|
Definition
| requires large amounts of potassium within first 24-36 hours |
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|
Term
| During initial therapy the serum potassium concentration may fall rapidly due to |
|
Definition
| action of insulin promoting reentry into cells; dilution of extracellular fluid; correction of acidosis; increased urinary loss of potassium |
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|
Term
| Fluid and insulin therapy alone |
|
Definition
| usually lowers the potassium level rapidly |
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|
Term
| should be added to IV when level drops below 5.5 mEq/L |
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Definition
|
|
Term
|
Definition
| KCl 100-200 mEq usually is required |
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|
Term
| replacement during txt of DKA is controversial; recommended not treating until level less than 1 mg/dL |
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Definition
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|
Term
| osmotic diuresis may cause significant depletion; symptoms in DKA are rare as is need of IV therapy |
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Definition
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|
Term
| role in DKA debated for decades; routine use not recommended |
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Definition
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|
Term
| main contributors to mortality |
|
Definition
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|
Term
|
Definition
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|
Term
| Severe hyperglycemia, elevated calculated plasma osmolality (>315); serum bicarb > 15; ph > 7.3; |
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Definition
|
|
Term
|
Definition
| decreased utilization of insulin, increased hepatic gluconeogenesis and glycogenolysis, impaired renal excretion of glucose |
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|
Term
| commonly prescribed drugs that may predispose to hyperglycemia, volume depletion, or other effects leading to HHS |
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Definition
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|
Term
|
Definition
| higher osmolality, higher hyperglycemia, greater volume contraction |
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|
Term
|
Definition
| initial rates of 500-1500 ml/hr during first 2 hours followed by rates of 250-500 ml per hour are usually well tolerated |
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|
Term
| these patients are at highest risk for cardiac dysrhythmia and should be treated with urgency |
|
Definition
|
|
Term
|
Definition
| continuous infusion of 0.1U/kg/hour is best |
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