Upload
terdsak-rojsurakitti
View
2.320
Download
2
Tags:
Embed Size (px)
Citation preview
Definition
Lab
Treatment Complications
Pathophysiology
Signs and Symptoms
Etiology
Diagnosis
contents
•Diabetic ketoacidosis is near complete deficency of insulin and elevated levels of stress hormones glucagon
cathecolamine cortisol
growth hormone •acute metabolic complication of diabetic characterized by
Hyperglycemia hyperketonemia metabolic acidosis
Defination
DKA is a life-threatening compDKA is a life-threatening complication in Pt. with untreated DM
(chronic high blood sugar or hyperglyce mia).
DKA occurs mostly in type 1 DM DKA is less common in type 2 DM, but it may occur in situations of physiologic stress . Pts . with new undiagnosed Type 1 DM frequently present to hospitals with DKA
Definition
Etiology
Insulin deficiency c relative or absolute increase in glucagon(Inadequate insulin administration)
Infection or Inflammation ( pneumonia, UTI, gastroenteritis, sepsis)
Ischemia or Infarction ( cerebral, coronary, mesenteric, peripheral)
Intra-abdominal process (pancreatitis, cholecystitis)
1 . Hyperglycemia :gluconeogenesis, glycogenolysis ,↓glucose uptake into cell (underutilization) 2. Ketosis : lipolysis, keto genesis , ↓ Peripheral tissu -- e uptake ketone )ketonemia 3 . Hypertriglyceridemia : ↑free fatty acid 4. Osmotic diuresis :hyperglycemia -- ) renal loss glucose, Na & K -- )electrolyte imbalance 5 . Volume depletion : h yperglycemia, glucosuria & -- osmotic diuresis )dehydration
Pathophysiology
S igns and S ymptoms Initial symptoms of DKA
Anorexia, nausea, vomiting, abdominal pain Polyuria, polydipsia
-- Dehydration ) dry mucous membranes, tac hycardia, hypotension
Alterated mental function-- ) somnolence, stupor,coma
Fever is not a sign of DKA -- )signifies underly ing infection
Classic signs of DKA
Kussmaul ‘ s respirations (deep) to comp ensate for metabolic acidosis
with acetone odor on Pt. breath
Signs and Symptoms
การตรวจทางห้�องปฏิ�บั�ต�การเบั��องต�น1 . Glucose & ketone in serum & urine 2 . Serum electrolyte, BUN, Cr, Ca, PO4 3 . Blood gas : capillary or arterial blood gas4 . EKG : hypo /hyperkalemia5 . CBC UA
Lab
Serum glucose ) 300 mg/dl
3Acidosis : serum HCO < 15 /mEq ml orpp < 725. severity of ppp Mild : HCO3 > 15-18 mq/L & pH > 7.3 Moderate : HCO3 10-15 mq/L & pH 7.1-7.3 Severe : HCO3 < 10mq/L & pH<7.1
Ketone : positive ketone in urine and /pp ppppp
Diagnosis
Confirm Dx : ↑ BS, positive serum keton e, metabolic acidosisAdmit Assess
Serum electrolyte : K, Na, Mg, Cl, HCO3, PO4
- Acid base status : pH, H CO3, Pco2Renal function : creatinine, urine output
Replace fluidAdminister regular insulin / RI Assess patient
What precipitated the episode Initial appropriate work up
Treatment
Measure capillary glucose every 1-2 hr/ E ’lyte, anion gap e
very 4 hr for first 2 4 hr - MonitorBP, PR, respiration, mentalstatus, fluidi nt ake/out put ever y 1 4hh hhhhhhh h Continue above until Pt . stable hhhhhhhhhh intermediate or long – act i ng i nsul i n as soon as Pt . eating / overlap in insulin infusion & su
bcutaneous injection.
Treatment
•Hypolycemia •Electrolyte imbalance •Hyperlycemia •Metabolic acidosis •Cerebraledema•Hypoxemia,ARDS•Thrombotic events:CVA,MI
Complication