Page 224 - Critical Care Notes

4223_Tab08_216-229 29/08/14 8:26 AM Page 218

ENDO
DKA can also be caused by a lack of insulin → ↑ breakdown of fat →↑ fatty
acid and glycerol → fatty acids converted into ketones → metabolic acidosis → ↑
respiratory rate and abdominal pain, and acetone breath. Can lead to hyper-
+
kalemia, hypoxemia, coma, and death. For every 0.1 change in pH → change in K .
Clinical Presentation
■ Severe hyperglycemia
■ Polyuria, polydipsia
■ Dry mucous membranes, thirst, loss of skin turgor, dehydration
■ Weakness, malaise, fatigability
■ Headache
■ Ketonic (acetone) or fruity breath
■ Anorexia, nausea and vomiting, diarrhea, weight loss
■ Abdominal pain or cramps, usually generalized or epigastric
■ Rigid abdomen, irregular bowel sounds
■ Tachypnea or Kussmaul’s respirations
■ Hypothermia
■ Hypotension and tachycardia; shock
■ Glycosuria
■ Ketones in blood and urine
■ Metabolic acidosis: pH <7.3, bicarbonate <15 mmol/L, blood glucose
>14 mmol/L, ketonuria
■ Lethargy, coma, stupor
Diagnostic Tests
■ ECG
■ Chest x-ray
■ Urinalysis (note presence of ketones)
■ CBC
■ Serum electrolytes and chemistries, glucose and ketone levels, BUN, and
creatinine
■ Urine, sputum, and wound and blood cultures if infection suspected
■ ABGs and ↑ anion gap (8–16 mEq/L or 8–16 mmol/L normal)
■ Serum osmolarity (↑)
■ Cardiac enzymes
■ Amylase and lipase levels
NOTE: Serum and urine should be negative for ketones. High serum glucose
levels → osmotic diuresis → dilutional hyponatremia and hypokalemia and
dehydration.

218