Professional Documents
Culture Documents
Dka New
Dka New
Dka New
Presented by
Capt Imran Haider
Khan
House Officer
CMH Bwp
1
HISTORY OFOF
HISTORY PRESENTING ILLNESS
PRESENTING ILLNESS
Name : XYZ
Age: 15yrs
Student
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HISTORY CONT..
PAST MED/SURG/DRUG HX
T1DM from last 07 years
FAMILY HX
Non-significant
PERSONAL HX
Non-significant
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GENERAL PHYSICAL EXAMINATION
VITALS
BP 108/58mmHG
PULSE 147/min
TEMP 98’F
R/R 30/min
SP02 98%
BSR 523mg/dl
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SYSTEMIC REVIEW
GPE CVS
• Tachypnea S1 + S2 + 0
• Unconscious
• Acidotic breathing CNS
Plantars
ABDOMEN
• Soft + Tenderness on deep
palpation, No visceromegaly.
CHEST
• B/L Air entry
• B/L Vesicular breathingeathing
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INVESTIGATIONS
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INVESTIGATIONS
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DIAGNOSIS
DIABETIC KETOACIDOSIS
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IMMEDIATE MANAGEMENT
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SEQUENCE OF EVENTS
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SEQUENCE OF EVENTS
SEQUENCE OF EVENTS
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DIABETIC KETOACIDOSIS
CASE DISCUSSION
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INTRODUCTION
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EPIDEMIOLOGY
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ETIOLOGY
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CLINICAL PRESENTATION
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SIGNS
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DIAGNOSIS
BSPED Guidelines
• Capillary blood glucose above 11 mmol/L
• Capillary ketones above 3 mmol/L or Urine ketones ++ or more
• Venous PH less than 7.3 and/or bicarbonate <15 mmol/L
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LABORATORY EVALUATION
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SEVERITY OF DKA
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MANAGEMENT
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INITIAL FLUID REPLACEMENT
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0 TO 60 MINUTES
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60 MINUTES TO 06 HOURS
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6 TO 12 HOURS
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12 TO 24 HOURS
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RESOLUTION OF DKA
Resolution is defined as ketones <0.3 mmol/L and venous
PH >7.3
Patient should be eating,drinking and back to normal
insulin
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CORRECTION OF FLUID LOSS
• It is a critical part of treating patients with DKA.
• Use of isotonic saline.
• 15-20mL/kg/hour for the first few hours.
• Recommended schedule:
• Administer 1-3 L during first hour.
• Administer 1 L during second hour.
• Administer 1 L during the following 2 hours.
• Administer 1 L every 4 hours, depending on the degree of dehydration
and CVP.
• When patient becomes euvolemic, switch to 0.45%
saline is recommended, particularly if hypernatremia
exists. 31
INSULIN TH ERAPY
33
COMPLICATIONS
• CVT
• Myocardial Infarction
• DVT
• Acute gastric dilatation
• Erosive gastritis
• Late hypoglycemia
• Respiratory distress
• Infection (UTI)
• Hypophosphatemia
• Mucormycosis
• CVA
• Cerebral edema (rare in adults)
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REFERENCES
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THANK YOU
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Thank you