What are the predisposing factors of DKA?
Things that may increase your risk of DKA are:
- Not taking insulin as prescribed or not taking insulin at all.
- Type 1 diabetes that has not been diagnosed.
- Stomach illness with a lot of vomiting.
- Infections such as pneumonia , urinary tract infection , or sepsis.
- Heart disease, such as heart attack.
- Recent stroke.
What precipitating factors cause DKA?
The most common precipitating factor in the development of DKA or HHS is infection. Other precipitating factors include cerebrovascular accident, alcohol abuse, pancreatitis, myocardial infarction, trauma, and drugs.
What causes hypokalemia in DKA?
DKA is a well-known cause of hypokalemia caused by osmotic diuresis leading to a total body potassium deficiency of 3 to 6 mEq/kg. At presentation, potassium levels are typically “normal” due to the extracellular shift of potassium (K+) from insulin deficiency and acidosis.
Why does anion gap increased in DKA?
Diabetic ketoacidosis (DKA) is a serious life-threatening complication of diabetes mellitus characterized with high anion gap metabolic acidosis due to excessive production of ketoacids at an expense of reduced serum bicarbonate concentration .
Why does Bicarb decrease 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.
Is there any lower limit of serum bicarbonate in diabetic ketoacidosis?
The characteristic abnormality consists of ketonemia and ketonuria and serum bicarbonate level of 18 mEq/L or less. When serum bicarbonate falls below 5 mEq/L, it indicates severe DKA.
Why do you give heparin in DKA?
In a patient with diabetic ketoacidosis complicated by severe elevation of plasma triglyceride concentrations, treatment with low-level intravenous unfractionated heparin led to prompt reduction in plasma triglyceride concentration and may have prevented the development of hypertriglyceridemia-associated acute …
How do you fix acidosis in DKA?
Key DKA management points
- Start intravenous fluids before insulin therapy.
- Potassium level should be >3.3 mEq/L before the initiation of insulin therapy (supplement potassium intravenously if needed).
- Administer priming insulin bolus at 0.1 U/kg and initiate continuous insulin infusion at 0.1 U/kg/h.
What is anion gap in diabetic ketoacidosis?
In mild DKA, anion gap is greater than 10 and in moderate or severe DKA the anion gap is greater than 12. These figures differentiate DKA from HHS where blood glucose is greater than 600 mg/dL but pH is greater than 7.3 and serum bicarbonate greater than 15 mEq/L.
How is anion gap calculated for DKA?
In clinical practice, the anion gap is calculated using three lab values (Na+, Cl-, and HCO3-). [Occasionally, you may see an alternative equation: Anion Gap = [Na+] + [K+] – [Cl-] – [HCO3-].