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Diabetic Ketoacidosis PowerPoint Presentation

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Description : A state of absolute or relative insulin deficiency aggravated by resulting hyperglycemia, dehydration, and acidosis. Can occur in both Type I Diabetes and Type II Diabetes. Diabetic ketoacidosis is characteristically associated with type 1 diabetes.It also occurs in type 2 diabetes under conditions of extreme stress.

Tags : diabetic ketoacidosis,DKA,Type I Diabetes,Type II Diabetes,Dehydration

Published on : Aug 14, 2025 | Views : 501 | Downloads : 0

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Slide 1-

Diabetic Ketoacidosis
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DKA A state of absolute or relative insulin deficiency aggravated by resulting hyperglycemia, dehydration, and acidosis Can occur in both Type I Diabetes and Type II Diabetes Diabetic ketoacidosis is characteristically associated with type 1 diabetes It also occurs in type 2 diabetes under conditions of extreme stress The presenting symptom for ~ 25% of Type I Diabetics
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Defining features A blood glucose >250 mg/dL Plasma HCO3 ≤ 18 mEq/L Plasma pH ≤7.30 Evidence of ketones in blood or urine
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KETOACIDS: Ketone bodies: Ketones When carbohydrates are not available for metabolic energy production, there is a breakdown of fat in adipose tissue (lipolysis) to form 3 ketone bodies; i.e., acetoacetate, β-hydroxybutyrate, and acetone These ketones can be used as fuels by vital organs such as the heart and central nervous system IN DKA THE FORMATION OF KETONES IS INCREASED
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Precipitating Factors Insulin omission – MOST COMMON CAUSE of DKA New diagnosis of diabetes Infection (pneumonia, UTI) Myocardial infarction Trauma Thyrotoxicosis Drugs(alcohol,steroids) Stroke
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Dehydration is almost universal in DKA, volume deficits in DKA average 50–100 mL/kg (4–8 L for an 80 kg adult) Potassium depletion is universal in DKA, and the average deficit is 3 to 5 mEq/kg However, the initial serum K + is often normal (74% of patients) or even elevated (22% of patients)
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Symptoms of DKA Polyuria (Excessive urine output) Polydypsia (Excessive Thirst) Blurred vision Nausea/Vomiting Abdominal Pain Fatigue Confusion/Coma
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Physical Examination Hypotension, tachycardia Kussmaul breathing (deep, labored breaths) Fruity odor to breath (due to acetone) Dry mucus membranes Confusion Abdominal tenderness
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LABORATORY checks Serum glucose Serum electrolytes , blood urea nitrogen (BUN), and serum creatinine Complete blood count Urinalysis urine ketones by dipstick (false +ve or false –ve possible) Arterial blood gas ECG
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IV fluids If hypotensive, normal saline (0.9%) 1-2L/hr to correct hypotension THEN Normal saline – 500-1000 cc/hr for 4 hours, then 250 – 500 cc/hr for 4 hours, then 125-250 cc/hr
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IV fluids Additionally, ongoing losses e.g. urine output, must be replaced to be able to correct dehydration When the blood glucose falls to 250 mg/dL, change the intravenous fluid to 5% dextrose in 0.45% saline and decrease the infusion rate to 150–250 mL/hr
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Potassium If the initial serum K+ is low (<3.3 mEq/L), the insulin should be withheld until the serum K+ can be normalized (by giving 10–40 mEq potassium chloride hourly) If the serum K+ is high (≥5 mEq/L), no potassium is given initially when the serum K+ is normal, 20–30 mEq of KCL should be added to each liter of IV fluid
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Replace Potassium: Hypokalemia is an avoidable cause of death in DKA Correct K+ first THEN start insulin
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Insulin Insulin therapy is started with regular insulin given intravenously, starting with a bolus dose of 0.15 units per kilogram body weight and followed with a continuous infusion at 0.1 units/kg/hr The blood glucose levels should decrease by 50 to 100 mg/dL per hour , and the insulin infusion should be adjusted to achieve this goal
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Insulin When the blood glucose level falls to 200 -250 mg/dL, the insulin infusion should be decreased to 0.05 to 0.1 units/kg/hr, and dextrose should be added to the intravenous fluids Thereafter, the blood glucose levels should be maintained between 150–200 mg/dL Achieving euglycemia is not recommended because of the risk of hypoglycemia
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Monitoring Blood glucose level should be checked, every 1 hour initially, then every 2 hours The serum K+ should be checked every 1–2 hours for the first 4–6 hours pH,HCO3 should be checked every 2-4 hours initially, then as needed
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Bicarbonate therapy Bicarbonate therapy does not improve the outcome in DKA, and is not recommended as a routine measure However, in patients with a pH <7.0, bicarbonate can be used to bring the pH to 7.0
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AFTER DKA RESOLVES When DKA has resolved (i.e., glucose <200 mg/dL, plasma [HCO3] >18 mEq/L, plasma pH >7.3) and the patient can tolerate oral fluids, subcutaneous insulin can be started Patients who were insulin-dependent prior to admission can be placed on their usual outpatient regimen
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Fluids, Potassium, Acidosis are the Pillars of Treatment Always Search for precipitating cause
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THANK YOU