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Diabeetus the Keto Acidizitations! (Diagnostics (Ketones (urine (glucose),…
Diabeetus the Keto Acidizitations!
Etiology
Unknown DMI
Not doing your insulin thang
Stupidity
Infections
Patho
Insulin deficiency
Hepatic glucose overproduction
Hyperglycemia
No glucose absorption
Glucose filters into kidney tubules
Osmotic gradient draws water in
K, Na, Ca, Phosphate drawn in
Excessive urination = dehydration and electrolyte loss
Intracellular dehydration: hydrostatic pressure draws fluid out of cells
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Acute Circulatory Failure
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Acidosis promotes H into cells
K is excreted out
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Lipolysis for glucose
Produces Acdic Ketones in circulation
Bicarb buffers fail to maintain pH
pH <7.3 = Acidosis
Kussmaul Breathing: Remove CO2
S&S
N+V
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Polyuria
Polydipsia
Polyphasia
Poor tissue perfusion
Lactic Acidosis
Diagnostics
Glucose ≥14.0 mmol/L
Increased anion gap [Na - (Cl + HCO3)] > (12 mmol/L)
Sodium (pseudohyponatremia from hyperglycemia)
Potassium (total body deficit of 3-5 mEq/kg)
Bicarbonate (<15 mEq/L)
BUN/Creatinine
Ketones
serum
urine
glucose
Arterial pH ( < 7.3)
Serum osmolarity
The Treatments
IV NS to euvolemic
Adjust to NS/half NS based on serum Na/Osmolarity
Prevents cerebral edema
Start KCL infusion until good K levels
Start insulin monitoring K serum for hypokalemia
Insulin will activate Na/K pumps
Continue insulin until pH & anion gap normalizes