Diabetic Ketoacidosis and HHS Flashcards

A patient with HHS is treated with IV fluids. After 4 liters of 0.9% NaCl, glucose is 600 mg/dL and osmolality is 340. What is the next most appropriate fluid?

Answer: Switch to 0.45% NaCl

After initial volume resuscitation with isotonic saline, 0.45% NaCl (hypotonic) is used to replace free water deficit and gradually correct hyperosmolality in HHS.

Which electrolyte abnormality is most commonly responsible for fatal cardiac arrhythmias during DKA treatment?

Answer: Hypokalemia

Hypokalemia, resulting from insulin-driven cellular uptake of potassium during DKA treatment, is the most common cause of fatal cardiac arrhythmias.

A 45-year-old alcoholic presents with vomiting, abdominal pain, glucose of 95 mg/dL, pH 7.22, and large serum ketones. Which diagnosis is most consistent?

Answer: Alcoholic ketoacidosis

Alcoholic ketoacidosis (AKA) presents with ketoacidosis, near-normal or low glucose, and a history of alcohol use and decreased oral intake.

Which criterion must be met before transitioning a DKA patient from IV to subcutaneous insulin?

Answer: Anion gap closure AND ability to eat

DKA resolution requires anion gap closure, pH >7.3, and bicarbonate >18; the patient must also be able to tolerate oral intake before transitioning to subcutaneous insulin.

What is the most appropriate initial insulin bolus regimen for moderate-to-severe DKA in an adult?

Answer: IV infusion at 0.14 units/kg/hr without a bolus

Current ADA guidelines recommend starting IV insulin at 0.14 units/kg/hr without a bolus as an alternative to the bolus-then-infusion approach, showing equal efficacy.

A patient with HHS develops focal neurological deficits during treatment. What is the most likely etiology?

Answer: Thrombotic stroke due to hyperviscosity

HHS is associated with a hypercoagulable, hyperviscous state that increases risk of arterial and venous thrombotic events, including ischemic stroke.

Which finding on urinalysis is LEAST reliable for diagnosing DKA?

Answer: Urine ketones (nitroprusside reaction) strongly positive

The urine nitroprusside reaction detects acetoacetate but not beta-hydroxybutyrate (the predominant ketone in DKA), so it can underestimate ketosis, especially early in treatment.