Diabetic Ketoacidosis Management Flashcards
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Read the first 7 Diabetic Ketoacidosis Management flashcards as text
In DKA, the serum potassium is initially high despite total body potassium depletion. What is the primary mechanism?
Answer: Acidosis-driven transcellular shift of potassium out of cells
Metabolic acidosis causes H⁺ to shift into cells in exchange for K⁺ moving out, raising serum potassium despite total body depletion.
A patient with DKA has serum phosphate of 0.8 mg/dL. In which clinical scenario would phosphate replacement be most strongly indicated?
Answer: Symptomatic hypophosphatemia with cardiac dysfunction or respiratory failure
Phosphate replacement is indicated in DKA when hypophosphatemia is symptomatic or associated with cardiac/respiratory dysfunction.
Which finding best differentiates DKA from hyperglycemic hyperosmolar state (HHS)?
Answer: Anion gap metabolic acidosis with significant ketonemia
DKA is characterized by significant ketonemia and anion gap acidosis, whereas HHS has minimal or no ketosis.
What is the expected rate of glucose decline per hour with appropriate insulin therapy in DKA?
Answer: 50–75 mg/dL/hr
Optimal insulin therapy lowers blood glucose by 50–75 mg/dL per hour; faster drops risk cerebral edema especially in children.
A patient with DKA on insulin infusion develops glucose of 180 mg/dL but still has an anion gap of 20. What is the appropriate management?
Answer: Add dextrose to IV fluids and continue insulin infusion
When glucose reaches 200–250 mg/dL but the anion gap remains elevated, add dextrose to maintain glucose while continuing insulin to clear ketones.
Which laboratory test provides the most accurate real-time assessment of ketone clearance in DKA?
Answer: Serum beta-hydroxybutyrate level
Serum beta-hydroxybutyrate directly measures the predominant ketone in DKA and is more accurate than urine dipstick or acetoacetate alone.
A patient with known type 1 diabetes is NPO for surgery scheduled tomorrow morning. How should insulin be managed to prevent DKA?
Answer: Continue basal insulin at full dose; hold prandial insulin
Basal insulin should be continued (sometimes at 75–80% dose) during NPO periods to prevent DKA; prandial insulin is held when there is no oral intake.