Diabetic Dka

8/2/2019 Diabetic Dka

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KETOACIDOSIS(DKA)KETOACIDOSIS(DKA)

PRESENTED BY:

S.MATHANAGOPALAN.



INTRODUCTIONINTRODUCTION

DKA is the combination of dehydration andacidosis.

It is characterized as the biochemical triadinvolving:

- Hyperglycaemia(blood glucose higher than250 mg/dl)

- Excessive ketoacids in blood and urine.

- Metabolic acidosis-PH below 7.3.

It occurs in people with type1 diabetes either atonset, or in

people with established diabetes.

DKA in people with pre-existing type2 diabetesoften



CAUSES OF DKACAUSES OF DKA

Insulin omission ssssor poor adherence to theinsulin regimen.

(It’s may be due to poor finance , inability toacquire insulin

or improper understanding of the criticalneed for insulin)

Alcohol abuse

Trauma

Pulmonary Embolism

Myocardial Infraction



MECHANISM OF INSULINMECHANISM OF INSULIN

DEFICIENCYDEFICIENCY

INSULIN DEFICIENCY.doc

Reduced glucose uptake leads tohyperglycaemia.

Hyperglycaemia leads to increased osmoticdiuresis.

Shift of water and potassium from the cellsinto the extracellular space leads toketonuria.

The loss of potassium leads to decreasedglomerular filtration rate and retention of

glucose and ketoanions.

http://var/www/apps/conversion/current/tmp/scratch7607/C:/Users/SAKTHI/Documents/INSULIN%20DEFICIENCY.doc

http://var/www/apps/conversion/current/tmp/scratch7607/C:/Users/SAKTHI/Documents/INSULIN%20DEFICIENCY.doc



KETONESKETONES

• Normal blood ketone level is < 0.5mmol/l.

TYPES OF KETONES:

Acetone(Excreted from lung and present inurine)

Acetoacetate (Excreted in the urine)

Beta-hydroxybutane(Present in the bloodnot in urine)



SIGNS AND SYMPTOMS OFSIGNS AND SYMPTOMS OF

DKADKAEarly symptoms of DKA are the same ashyperglycaemia like increased thirst andfrequent urination.

Nausea and vomitting.

Abdominal pain.Leg cramps.

Acid smelling breath.

Kussmaul’s breathing.



DIAGNOSISDIAGNOSIS

KETONES: Blood>3mmol/l

Urine moderate to large

MILD:PH 7.25 & 7.30

Serum bicarbonate: 15 to18mmol/l.

MODERATE:PH 7.00 to 7.25

Serum bicarbonate:10 to15mmol/l.

SEVERE:PH<7.00

Serum bicarbonate: lessthan10mmol/l.



DIAGNOSIS Contd….DIAGNOSIS Contd….

High blood glucose level and ureal creatinine,dehydration.

Cardiac monitoring –This is very important insevere DKA to access the possibility of heart

attack.



GOALSGOALS

Improving the circulating volume and tissueperfusion.

Decreasing serum glucose and osmolaring.

Cleaning blood and urine ketones.

Correcting the electrolyte imbalances.



TREATMENT TREATMENT

INSULIN:• The recommened insulin infusion dose is 0.1

unit/kg/hour. FLUID:•

Fluid replenishment is essential in the initialtreatment of DKA to reverse the hydration.

• Blood glucose levels are lowered byimproving the Renal perfusion.

•

Shock and severe dehydration must becorrected with normal saline.• Dextrose should be added to the replacement

fluids when the blood glucose falls below 250mg/dl.



TREATMENT Contd… TREATMENT Contd…

POTASSIUM: It ‘s replacement should not be starred until

the serum plasma concentration is less than5.5 mEq/l.

Unless the person present with hypokalaemia.Electrocardiogram monitoring should be done

during the potassium replacement.



BLOOD GLUCOSEBLOOD GLUCOSE

MONITORINGMONITORING If the blood glucose level have not to be

dropped by 45 to 54 mg/dl in thefirst hour.

Rapid fall in blood glucose is increased , It is

the risk of cerebral oedema.Monitoring the overload , headaches and

changes in cerebral function is important.



DKA RECOVERYDKA RECOVERY

Treatment may result in rapid improvementparticularly in children.

Once conciousness is reestablished with thepeople,it should be starred on the oral fluids

and food. It is safe to start subcutaneous.Short(or) rapid acting Insulin.

Soluble Insulin must be given 30 to 60minutes before stopping the IV insulin

infusion.Potassium containing drinks and foods may

be helpful to complete the procells ofsreplacing the entire deficit.



THANK YOU