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39 Cards in this Set
- Front
- Back
Diabetic ketoacidosis
-due to |
-severe insulin deficiency
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Diabetic ketoacidosis
-reason for ketone accumulation |
-impaired FA metabolism
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Diabetic ketoacidosis
-needs what for resolution |
-insulin
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Diabetic ketoacidosis
-why is there a low pH |
-ketones lower pH
-ketones = metabolic acids |
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Diabetic Ketoacidosis
-can be precipitated by |
-inadequate insulin therapy
-physiologic stress -drugs affecting insulin production/action -bacterial infection -decreased fluid intake |
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Diabetic ketoacidosis
-presenting signs for recognition in the ER |
-inconsistent presentation from mild illness to coma
-PU/PD -Lethargy & weakness -inappetance -vomiting -neurologic abnormalities -emaciation -acetone odor -recent illness/drug therapy |
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Diabetic ketoacidosis
-major drug therapy that can predispose for disease |
-steroid
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Diabetic Ketoacidosis
-physical exam |
-dehydration
-hypo-/hyperthermia -signs of hypovolemic shock -neurologic abnormalities -evidence of diabetes -signs of concurrent disease (abdominal pain, jaundice) |
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Signs of hypovolemia and shock
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-tachycardia
-poor pulse strength -poor perfusion |
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ABCs of emergency room signs
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-airways
-breathing -circulation |
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Diabetic ketoacidosis
-Lab findings |
-hyperglycemia/glucosuria
-hyperketonemia/ketonuria -azotemia -electrolyte abnormalities -metabolic acidosis -abnormalities from concurrent illness |
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Diabetic ketoacidosis
-reason for metabolic acidosis |
-dec. in blood pH and in bicarbonate concentration due to ketone production
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Diabetic ketoacidosis
-electrolyte abnormalities |
-hyponatremia
-hypochloremia -hypokalemia Develop after insulin therapy: -hypophosphatemia -hypomagnesemia |
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Diabetic ketoacidosis
-reason for elevated anion gap |
=production of ketoacid anions
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Diabetic ketoacidosis
-reason for hyperosmolarity |
-markedly elevated serum glucose increases the effective serum osmolarity
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Diabetic ketoacidosis
-reason for pre-renal azotemia |
-dehydration
-concurrent renal insufficiency |
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Diabetic ketoacidosis
-goals of treatment |
-volume replacement
-restore euglycemia -correct metabolic imbalances -systemic support |
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Diabetic ketoacidosis
-dehydration due to |
-osmotic diuresis (Na & glucose)
-protracted vomiting and diarrhea -decreased fluid intake (weakness, lethargy, anorexia) |
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Diabetic ketoacidosis
-dehydration treatment preferred fluids |
-Intravenous crystalloids (0.9% NaCl)
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Diabetic ketoacidosis
-rate of fluid administration for treatment of dehydration |
Hypovolemic shock
-shock fluid dose to restore BP Dehydration -replace deficit -maintenance -replace loss Replace the deficit over 6-12 hrs |
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Shock fluid dose for dogs
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-90 mL/kg/hr
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Shock fluid dose for cats
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-50 ml/kg/hr
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Diabetic ketoacidosis
-effect of rehydration on electrolyte disturbances |
-replenished stores of sodium and potassium with use of isotonic saline and supplemented potassium
-possible decrease in serum magnesium and phosphate |
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Diabetic ketoacidosis
-effect of rehydration on acid/base status |
-restored tissue perfusion (enhanced oxygen delivery to tissues --> dec. lactate)
-enhanced urine production (increased excretion) |
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Diabetic ketoacidosis
-effect of rehydration on hyperosmolarity and hyperglycemia |
-dec. serum glucose via dilution
-promoted renal loss of glucose via urination |
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Diabetic ketoacidosis
-how to restore euglycemia |
Use short acting insulin (regular)
-administer IV or IM -CRI or intermittent therapy |
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Diabetic ketoacidosis
-for how long should insulin be used |
-until ketoacidosis is resolved
-supplement with glucose if hypoglycemia occurs |
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Diabetic ketoacidosis
-why should insulin not be administered SQ |
-dehydration decreases absorption
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Diabetic ketoacidosis
-2 major goals of insulin therapy |
-control hyperglycemia
-stop ketogenesis |
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Diabetic ketoacidosis
-target glucose level to reach with treatment |
- <250 mg/dl in 12 hrs
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Diabetic ketoacidosis
-why should insulin therapy wait until vascular volume is restored in some cases |
-insulin causes fluid and electrolyte movement into cells which can cause vascular collapse
-volume expansion will cause a dec. in serum glucose -inc. urine production will enhance renal glucose loss |
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Diabetic ketoacidosis
-treatment for metabolic imbalances |
Sodium
-add Na containing fluids Potassium -add KCl to crystalloid Phosphorus -phosphorus supplementation Magnesium -Magnesium chloride/magnesium sulfate supplementation |
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Most common electrolyte disturbance associated with diabetic ketoacidosis
-why? |
-hypokalemia
-body stores depleted -insulin drive potassium into cells |
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Diabetic ketoacidosis
-when is phosphorus supplementation indicated |
-<2.0 mg/dl
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Diabetic ketoacidosis
-what occurs if phosphorus levels get below 1.0 mg/dl |
-weakness
-hemolysis -possibly due to phosphorus needed for ATP, and RBC cell walls break down |
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Diabetic ketoacidosis
-glucose supplementation administration if needed |
-2.5-5% glucose CRI
-usually can just stop insulin for a few mins until glucose rises |
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Diabetic ketoacidosis
-when is treatment of acidosis indicated -what is administered |
-if severe academia is present after volume replacement
-bicarbonate |
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Diabetes mellitus
-common concurrent disorders |
-pancreatitis
-bacterial infection -endocrinopathy |
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Diabetic ketoacidosis
-treatment contraindications |
-steroids
-oral hypoglycemic drugs -depot insulin prep (slow release and prolonged action) |