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EMERGENCIES IN DIABETES
DIABETIC KETOACIDOSIS
AND
HYPERGLYCEMIC HYPEROSMOLAR STATE
DKA Statistics
• Type 1 Diabetes
• Occasionally in Type 2
– Infection, Trauma, Cardiac
– Newly diagnosed Type 2 DM
• More common in young people & women
• Mortality primarily due to precipitating illness
• Prognosis worse with
– Old Age, Coma, Hypotension
DKA Mortality
DKA
(DIABETIC KETOACIDOSIS)
• Occurs when muscle cells become so starved for energy that
body takes emergency measures & breaks down fat toxic
acids as ketones
• Most common type 1 DM insufficient insulin to adjust
raise of blood sugar
• Cause by extreme stress or illness
• Infection body produce adrenalin works against insulin
• Forget to take insulin
Pathophysiology of diabetic ketoacidosis (DKA) and
hyperglycemic hyperosmolar state (HHS)
laktic acid ↑
Signs & symptoms of DKA
• Goals
– Neurologically alert/intact : Plasma Osm <315
– Taking PO nutrition
– Resume regular diet
– Add long-acting insulin, based on prior dosing or
24 hr insulin requirements on drip
– Stop insulin infusion 1-2 hrs after SQ insulin dose
To Be Concern …!!!
• Anion Gap
• Osmolarity (Sodium corrected)
• Choice of Fluid Replacement
• Heart Function
• Renal Function
• Nutrition (Oral, PPN,TPN)
• Insulin Addition
Anion Gap
• It is calculated by subtracting the serum
concentrations of chloride and bicarbonate (anions)
from the concentrations of sodium and potassium
(cations):
Hemodialysis back up
EMERGENCIES IN DIABETES
Terima Kasih