Diabetic Ketoacidosis Management Flashcards
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Read the first 7 Diabetic Ketoacidosis Management flashcards as text
A patient in DKA is started on a normal saline infusion. After 2 liters, serum chloride is 112 mEq/L. What complication is developing?
Answer: Hyperchloremic non-anion gap metabolic acidosis
Large volumes of normal saline can cause hyperchloremic non-anion gap metabolic acidosis, which may obscure DKA resolution.
Which ketone body is predominantly elevated in DKA but NOT detected by the nitroprusside urine ketone test?
Answer: Beta-hydroxybutyrate
Beta-hydroxybutyrate is the predominant ketone in DKA but is not detected by nitroprusside-based urine/serum ketone tests.
A 45-year-old with type 2 diabetes on an SGLT-2 inhibitor presents with glucose of 210 mg/dL, pH 7.21, and elevated ketones. What is this presentation called?
Answer: Euglycemic DKA
SGLT-2 inhibitors can cause euglycemic DKA — elevated ketones and metabolic acidosis with near-normal blood glucose.
What is the recommended initial fluid bolus for an adult presenting in DKA with moderate dehydration?
Answer: 1 liter 0.9% NaCl over 1 hour
Initial resuscitation in DKA uses 1 L of isotonic (0.9%) normal saline over the first hour.
In DKA management, when is sodium bicarbonate administration currently recommended by most guidelines?
Answer: pH < 7.10 with hemodynamic instability or severe hyperkalemia
Sodium bicarbonate is generally reserved for severe acidosis (pH <7.0–7.1) complicated by hemodynamic compromise or life-threatening hyperkalemia.
A child with DKA develops a sudden headache and altered mental status 6 hours into treatment. What is the most feared complication?
Answer: Cerebral edema
Cerebral edema is a rare but potentially fatal complication of DKA in children, often occurring 6–12 hours into treatment.
Which insulin regimen is standard for inpatient DKA management in adults?
Answer: Continuous IV regular insulin infusion at 0.1 units/kg/hr
Continuous IV regular insulin at 0.1 units/kg/hr (after potassium is replete) is the standard of care for adult DKA.