Diabetic Ketoacidosis (DKA)

Introduction

DKA is a medical emergency, especially in Type 1 diabetes but can occur in Type 2.
It involves increased blood acidity.
Signs and Symptoms:
- Nausea, vomiting
- Polyuria (excessive urination)
- Polydipsia (excessive thirst)
- Weight loss
- Hyperventilation (Kussmaul breathing)

Insulin Role:
- Produced by pancreas; in Type 1 diabetes, B cells are attacked, reducing insulin production.
- Decreased insulin leads to:
  - Increased gluconeogenesis, glycogenolysis
  - Decreased glycolysis resulting in hyperglycemia
  - Glucoseuria, polyuria, dehydration, and polydipsia
Fat Breakdown:
- Occurs due to lack of glucose uptake, leading to:
  - Breakdown of fat into free fatty acids
  - Ketogenesis in liver resulting in high levels of ketone bodies
  - Ketonemia and ketonuria (high ketones in blood and urine)
- Ketones are acidic, reducing blood and urine pH

Initial Steps:
- Thorough history and examination
- Check airways, breathing, circulation (ABC)
Circulatory Support:
- IV access for blood investigations
- Administer IV fluids (saline) and insulin slowly
Investigation and Monitoring:
- Perform arterial blood gas (ABG) to measure blood pH
- Monitor full blood count and electrolytes
- Check urine analysis for glucose and ketones
- ECG to check for arrhythmias due to potassium imbalance

Regular ABG checks to monitor pH
Continuous serum potassium level monitoring
Potential Risks:
- Insulin administration can cause hypokalemia, leading to arrhythmias
- Calcium gluconate can be used to protect heart from hypokalemia-induced arrhythmias
Fluid Management:
- Switch to 0.5% saline and 5% dextrose when blood glucose levels drop to ~14 mmol/L
Key Points:
- Continuous monitoring of bloods, electrolytes, ABG
- Monitor urine output, pH, glucose, and ketones

DKA requires immediate attention and treatment.
Essential to monitor and adjust treatment based on ongoing investigations and patient response.