SlideShare una empresa de Scribd logo
1 de 19
DIABETIC KETOACIDOSIS- DIAGNOSIS
AND MANAGEMENT
jason zachariah
WHEN TO SUSPECT DKA?

 Altered consciousness is the most common
  cause for seeking medical attention. It may
  range from mild disorientation to frank coma.
 Insidious increased thirst and urination are
  common early symptoms.
 Nausea and vomiting, diffuse abdominal
  pain.
 Generalized weakness and fatiguability.
 Symptoms of possible intercurrent infection-
  fever, dysuria, malaise and arthralgia
 History of rapid weight loss is a symptom in
  patients who are newly diagnosed with type
  1 diabetes
PHYSICAL FINDINGS

 Signs of dehydration- weak and rapid pulse,
  dry tongue and skin, hypotension, and
  increased capillary filling time.
 Odour of breath: characteristic acetone
  odour
 Signs of acidosis: kussmaul or sighing
  respiration, abdominal tenderness, and
  altered sensorium
   Signs of intercurrent illnesses: MI, UTI,
    pneumonia and perinephric abscess.
CARDINAL BIOCHEMICAL FEATURES

 Hyperglycemia >250mg/dl
 Hyperketonemia

 Metabolic acidosis- pH<7.3, HCO3 <15meq/L
INVESTIGATIONS:

 Venous blood: glucose, urea, electrolytes-
  (Na,K,HCO3)
 Arterial blood gases

 Urine-ketone bodies

 Infection screen- CBP, blood and urine
  culture, C-reactive protein, Chest Xray
URINE

   Highly positive for glucose and ketones.
    Rarely ketones may test negative in urine,
    because laboratory tests can detect only
    acetoacetate, while predominant ketone in
    severe untreated DKA is beta
    hydroxybutyrate. As clinical condition
    improves, it tests positive because of its
    breakdown to acetoacetate.
BLOOD AND PLASMA
 Glucose: may be as low as 250 mg/dL to as
  high as more than 800 mg/DL
 Sodium: The osmotic effect of hyperglycemia
  moves extracellular water to intravascular
  space. For each 100mg/dL of glucose over
  100mg/dL, the serum sodium is lowered by
  approximately 1.6 mEq/L. When the glucose
  level falls, serum sodium will rise.-
  pseudohyponatremia
BLOOD (CONT’D)

   Potassium: elevated H+ drives the
    intracellular potassium to extracellular
    compartment and secondary aldosteronism
    drives the K+ cells from the kidney into urine.
 Serum     potassium levels do not reflect
    the state of total body potassium.
BLOOD (CONT’D)

 Bicarbonate: used in conjunction with anion
  gap to assess degree of acidosis
 CBC- high WBC counts>15000 or marked
  left shift suggests underlying bacterial
  infection
 ABG: pH<7.3
BLOOD (CONT’D)

 Osmolarity: =2(Na+)meq/L + glucose mg/dL
  +BUN mg/dL by 4
Usually >330 mOsm/kg H20. If osmolarity is
  less than this in a comatose patient, search
  for another cause of obtundation
 Phosphorus: phosphate levels

 High anion gap a usual finding.

Anion gap= Na-(Cl+HCO3)
OTHER TESTS

 Ecg- DKA maybe precipitated by a cardiac
  event
 Chest Xray- to rule out pulmonary infection
MONITORING

   Repeated monitoring of biochemistry is
    critical. Potassium needs to be checked
    every 1 to 2 hours during initial treatment.
    Glucose and other electrolytes should be
    checked every 2 hours or so.
DIFFERENTIAL DIAGNOSIS

 Lactic acidosis- serum glucose,ketones nl,
  lactate>5mm
 Saturation ketosis: urine ketone +ve, blood
  ketone –ve, arterial pH usually normal
 Alcoholic ketoacidosis: history of alcohol
  being main energy source for few days, strip
  test often -ve, normoglycemia or
  hypoglycemia common
DIFFERENTIAL DIAGNOSIS

 Uremic acidosis- normoglycemia
 Rhabdomyolysis: increased CPK

 Salicylate toxicity: normoglycemia, ketones
  negative
Dka jason

Más contenido relacionado

La actualidad más candente

Diabetic ketoacidosis
Diabetic ketoacidosisDiabetic ketoacidosis
Diabetic ketoacidosisPinky Rathee
 
Diabetic keto acidosis
Diabetic keto acidosisDiabetic keto acidosis
Diabetic keto acidosisDr. Tanmoy Roy
 
Dka, hhns.pptx1
Dka, hhns.pptx1Dka, hhns.pptx1
Dka, hhns.pptx1arnoldtchu
 
Dka diabetic ketoacidosis managment
Dka diabetic ketoacidosis managmentDka diabetic ketoacidosis managment
Dka diabetic ketoacidosis managmentEyad Miskawi
 
Diabetic ketoacidosis
Diabetic ketoacidosisDiabetic ketoacidosis
Diabetic ketoacidosisMustafa Abd
 
Diabetic keto acidosis ppt
Diabetic keto acidosis pptDiabetic keto acidosis ppt
Diabetic keto acidosis pptshaikfouzia
 
Diabetic ketoacidosis by dr. noman
Diabetic ketoacidosis by dr. nomanDiabetic ketoacidosis by dr. noman
Diabetic ketoacidosis by dr. nomanAbdullah Al Noman
 
Diabetic Ketoacidosis Presentation
Diabetic Ketoacidosis PresentationDiabetic Ketoacidosis Presentation
Diabetic Ketoacidosis PresentationAimee Jalkanen
 
Diabetic keto acidosis in children ... Dr.Padmesh
Diabetic keto acidosis in children ...  Dr.PadmeshDiabetic keto acidosis in children ...  Dr.Padmesh
Diabetic keto acidosis in children ... Dr.PadmeshDr Padmesh Vadakepat
 
DKA Management Summary for Dept
DKA Management Summary for DeptDKA Management Summary for Dept
DKA Management Summary for DeptDarren Lee
 
Dka Management
Dka ManagementDka Management
Dka ManagementHome~^^
 
Diabetic Ketoacidosis
Diabetic Ketoacidosis Diabetic Ketoacidosis
Diabetic Ketoacidosis Leor Surilov
 
Diabetic Ketoacidosis
Diabetic KetoacidosisDiabetic Ketoacidosis
Diabetic KetoacidosisChicharito123
 

La actualidad más candente (20)

Diabetic ketoacidosis
Diabetic ketoacidosisDiabetic ketoacidosis
Diabetic ketoacidosis
 
Diabetic keto acidosis
Diabetic keto acidosisDiabetic keto acidosis
Diabetic keto acidosis
 
Diabetic Ketoacidosis
Diabetic KetoacidosisDiabetic Ketoacidosis
Diabetic Ketoacidosis
 
Diabetic ketoacidosis
Diabetic ketoacidosisDiabetic ketoacidosis
Diabetic ketoacidosis
 
Dka, hhns.pptx1
Dka, hhns.pptx1Dka, hhns.pptx1
Dka, hhns.pptx1
 
Dka diabetic ketoacidosis managment
Dka diabetic ketoacidosis managmentDka diabetic ketoacidosis managment
Dka diabetic ketoacidosis managment
 
Diabetic ketoacidosis
Diabetic ketoacidosisDiabetic ketoacidosis
Diabetic ketoacidosis
 
Diabetic keto acidosis ppt
Diabetic keto acidosis pptDiabetic keto acidosis ppt
Diabetic keto acidosis ppt
 
DKA
DKADKA
DKA
 
Diabetic ketoacidosis by dr. noman
Diabetic ketoacidosis by dr. nomanDiabetic ketoacidosis by dr. noman
Diabetic ketoacidosis by dr. noman
 
Diabetic Ketoacidosis Presentation
Diabetic Ketoacidosis PresentationDiabetic Ketoacidosis Presentation
Diabetic Ketoacidosis Presentation
 
DKA
DKADKA
DKA
 
Diabetic keto acidosis in children ... Dr.Padmesh
Diabetic keto acidosis in children ...  Dr.PadmeshDiabetic keto acidosis in children ...  Dr.Padmesh
Diabetic keto acidosis in children ... Dr.Padmesh
 
Diabetic Ketoacidosis
Diabetic KetoacidosisDiabetic Ketoacidosis
Diabetic Ketoacidosis
 
DKA Management Summary for Dept
DKA Management Summary for DeptDKA Management Summary for Dept
DKA Management Summary for Dept
 
Diabetic ketoacidosis DKA
Diabetic ketoacidosis DKADiabetic ketoacidosis DKA
Diabetic ketoacidosis DKA
 
KHA-HHS pp
KHA-HHS pp KHA-HHS pp
KHA-HHS pp
 
Dka Management
Dka ManagementDka Management
Dka Management
 
Diabetic Ketoacidosis
Diabetic Ketoacidosis Diabetic Ketoacidosis
Diabetic Ketoacidosis
 
Diabetic Ketoacidosis
Diabetic KetoacidosisDiabetic Ketoacidosis
Diabetic Ketoacidosis
 

Destacado

The Many Faces of Hyperparathyroidism & Advances in Treatment
The Many Faces of Hyperparathyroidism & Advances in TreatmentThe Many Faces of Hyperparathyroidism & Advances in Treatment
The Many Faces of Hyperparathyroidism & Advances in TreatmentBabak Larian
 
Lect 1-pituitary insufficiency
Lect 1-pituitary insufficiencyLect 1-pituitary insufficiency
Lect 1-pituitary insufficiencyMohanad Mohanad
 
Diabetic Ketoacidosis
Diabetic KetoacidosisDiabetic Ketoacidosis
Diabetic KetoacidosisEBMGoneWild
 
Hypo Pituitarism
Hypo  PituitarismHypo  Pituitarism
Hypo Pituitarismshabeel pn
 
Hypopituitarism diagnosis and management (1)
Hypopituitarism diagnosis and management (1)Hypopituitarism diagnosis and management (1)
Hypopituitarism diagnosis and management (1)rajeetam123
 
Diabetic Profile - Lab Diagnosis
Diabetic Profile  - Lab DiagnosisDiabetic Profile  - Lab Diagnosis
Diabetic Profile - Lab DiagnosisRavi Kumudesh
 
Hyperprolactinemia 3
Hyperprolactinemia  3Hyperprolactinemia  3
Hyperprolactinemia 3guest9dc181
 
Treatment and Prevention of Subclinical Hypocalcemia
Treatment and Prevention of Subclinical HypocalcemiaTreatment and Prevention of Subclinical Hypocalcemia
Treatment and Prevention of Subclinical HypocalcemiaDAIReXNET
 
Diabetic Keto acidosis DKA
Diabetic Keto acidosis DKADiabetic Keto acidosis DKA
Diabetic Keto acidosis DKAFarhan Shaikh
 
Disorders of parathyroid gland
Disorders of parathyroid glandDisorders of parathyroid gland
Disorders of parathyroid glandGarmyan Yawar
 
Parathyroid disorders
Parathyroid disorders Parathyroid disorders
Parathyroid disorders Rakesh Verma
 
Disorders of pituitary gland (( THE MASTER )) BY M.SASI
Disorders of pituitary gland (( THE MASTER  )) BY M.SASIDisorders of pituitary gland (( THE MASTER  )) BY M.SASI
Disorders of pituitary gland (( THE MASTER )) BY M.SASIcardilogy
 

Destacado (20)

Diabetic ketoacidosis
Diabetic ketoacidosisDiabetic ketoacidosis
Diabetic ketoacidosis
 
Gd oor 912
Gd oor 912Gd oor 912
Gd oor 912
 
Dka fss
Dka  fssDka  fss
Dka fss
 
The Many Faces of Hyperparathyroidism & Advances in Treatment
The Many Faces of Hyperparathyroidism & Advances in TreatmentThe Many Faces of Hyperparathyroidism & Advances in Treatment
The Many Faces of Hyperparathyroidism & Advances in Treatment
 
Lect 1-pituitary insufficiency
Lect 1-pituitary insufficiencyLect 1-pituitary insufficiency
Lect 1-pituitary insufficiency
 
Diabetic Ketoacidosis
Diabetic KetoacidosisDiabetic Ketoacidosis
Diabetic Ketoacidosis
 
Hypo Pituitarism
Hypo  PituitarismHypo  Pituitarism
Hypo Pituitarism
 
Hypopituitarism
HypopituitarismHypopituitarism
Hypopituitarism
 
Hypopituitarism diagnosis and management (1)
Hypopituitarism diagnosis and management (1)Hypopituitarism diagnosis and management (1)
Hypopituitarism diagnosis and management (1)
 
Diabetic Profile - Lab Diagnosis
Diabetic Profile  - Lab DiagnosisDiabetic Profile  - Lab Diagnosis
Diabetic Profile - Lab Diagnosis
 
parathyroid disorder
parathyroid disorderparathyroid disorder
parathyroid disorder
 
Hypoparathyroidisim
Hypoparathyroidisim Hypoparathyroidisim
Hypoparathyroidisim
 
Hyperprolactinemia 3
Hyperprolactinemia  3Hyperprolactinemia  3
Hyperprolactinemia 3
 
DKA case study
DKA case studyDKA case study
DKA case study
 
Treatment and Prevention of Subclinical Hypocalcemia
Treatment and Prevention of Subclinical HypocalcemiaTreatment and Prevention of Subclinical Hypocalcemia
Treatment and Prevention of Subclinical Hypocalcemia
 
Diabetic Keto acidosis DKA
Diabetic Keto acidosis DKADiabetic Keto acidosis DKA
Diabetic Keto acidosis DKA
 
Disorders of parathyroid gland
Disorders of parathyroid glandDisorders of parathyroid gland
Disorders of parathyroid gland
 
Hypocalcemia
HypocalcemiaHypocalcemia
Hypocalcemia
 
Parathyroid disorders
Parathyroid disorders Parathyroid disorders
Parathyroid disorders
 
Disorders of pituitary gland (( THE MASTER )) BY M.SASI
Disorders of pituitary gland (( THE MASTER  )) BY M.SASIDisorders of pituitary gland (( THE MASTER  )) BY M.SASI
Disorders of pituitary gland (( THE MASTER )) BY M.SASI
 

Similar a Dka jason

DIABETIC KETOACIDOSIS IN ER
DIABETIC KETOACIDOSIS IN ERDIABETIC KETOACIDOSIS IN ER
DIABETIC KETOACIDOSIS IN ERIsmat Alborhan
 
Hyperglycemic crises
Hyperglycemic crisesHyperglycemic crises
Hyperglycemic crises Mohamed BADR
 
Diabetic ketoacidosis.pptx
Diabetic ketoacidosis.pptxDiabetic ketoacidosis.pptx
Diabetic ketoacidosis.pptxNajiShlaibah
 
Diabetic emergencies.pptx
Diabetic emergencies.pptxDiabetic emergencies.pptx
Diabetic emergencies.pptxASUS38
 
Acute diabetic complication dr. mohamed ibrahim (1) (1)
Acute diabetic complication dr. mohamed ibrahim (1) (1)Acute diabetic complication dr. mohamed ibrahim (1) (1)
Acute diabetic complication dr. mohamed ibrahim (1) (1)DR.Mohamed Ibrahim youssef
 
Diabetic ketoacidosis dr jayesh vaghela
Diabetic ketoacidosis dr jayesh vaghelaDiabetic ketoacidosis dr jayesh vaghela
Diabetic ketoacidosis dr jayesh vaghelajpv2212
 
Diabetic Emergencies
Diabetic EmergenciesDiabetic Emergencies
Diabetic Emergenciesnawan_junior
 
acute complications of diabetes mellitus
acute complications of diabetes mellitus acute complications of diabetes mellitus
acute complications of diabetes mellitus Sandeep Yadav
 
DKA diabetes ketoacidosis in children.ppt
DKA diabetes ketoacidosis in children.pptDKA diabetes ketoacidosis in children.ppt
DKA diabetes ketoacidosis in children.pptssuser69abc5
 
Medical cme final (2).pptx
Medical cme final (2).pptxMedical cme final (2).pptx
Medical cme final (2).pptxssuser4c5351
 
6 fluid and electrolyte abnormalities
6 fluid and electrolyte abnormalities6 fluid and electrolyte abnormalities
6 fluid and electrolyte abnormalitiesEngidaw Ambelu
 
fluid_and_electrolyte_imbalance_0.ppt
fluid_and_electrolyte_imbalance_0.pptfluid_and_electrolyte_imbalance_0.ppt
fluid_and_electrolyte_imbalance_0.pptJerryZahid1
 

Similar a Dka jason (20)

Dka
DkaDka
Dka
 
DIABETIC KETOACIDOSIS IN ER
DIABETIC KETOACIDOSIS IN ERDIABETIC KETOACIDOSIS IN ER
DIABETIC KETOACIDOSIS IN ER
 
Hyperglycemic crises
Hyperglycemic crisesHyperglycemic crises
Hyperglycemic crises
 
Diabetic ketoacidosis.pptx
Diabetic ketoacidosis.pptxDiabetic ketoacidosis.pptx
Diabetic ketoacidosis.pptx
 
Seco dka
Seco dkaSeco dka
Seco dka
 
Diabetic emergencies.pptx
Diabetic emergencies.pptxDiabetic emergencies.pptx
Diabetic emergencies.pptx
 
Acute diabetic complication dr. mohamed ibrahim (1) (1)
Acute diabetic complication dr. mohamed ibrahim (1) (1)Acute diabetic complication dr. mohamed ibrahim (1) (1)
Acute diabetic complication dr. mohamed ibrahim (1) (1)
 
Diabetic ketoacidosis dr jayesh vaghela
Diabetic ketoacidosis dr jayesh vaghelaDiabetic ketoacidosis dr jayesh vaghela
Diabetic ketoacidosis dr jayesh vaghela
 
Diabetic Emergencies
Diabetic EmergenciesDiabetic Emergencies
Diabetic Emergencies
 
acute complications of diabetes mellitus
acute complications of diabetes mellitus acute complications of diabetes mellitus
acute complications of diabetes mellitus
 
Dka+hhs
Dka+hhsDka+hhs
Dka+hhs
 
Diabetic Ketoacidosis
Diabetic KetoacidosisDiabetic Ketoacidosis
Diabetic Ketoacidosis
 
Metabolic &amp; endocrine emergencies 2
Metabolic &amp; endocrine emergencies 2Metabolic &amp; endocrine emergencies 2
Metabolic &amp; endocrine emergencies 2
 
DKA diabetes ketoacidosis in children.ppt
DKA diabetes ketoacidosis in children.pptDKA diabetes ketoacidosis in children.ppt
DKA diabetes ketoacidosis in children.ppt
 
Acute Complication of DM by Dr Shahjada Selim
Acute Complication of DM by Dr Shahjada SelimAcute Complication of DM by Dr Shahjada Selim
Acute Complication of DM by Dr Shahjada Selim
 
Medical cme final (2).pptx
Medical cme final (2).pptxMedical cme final (2).pptx
Medical cme final (2).pptx
 
6 fluid and electrolyte abnormalities
6 fluid and electrolyte abnormalities6 fluid and electrolyte abnormalities
6 fluid and electrolyte abnormalities
 
Acute DM Complications
Acute DM ComplicationsAcute DM Complications
Acute DM Complications
 
Diabetic Crises
Diabetic CrisesDiabetic Crises
Diabetic Crises
 
fluid_and_electrolyte_imbalance_0.ppt
fluid_and_electrolyte_imbalance_0.pptfluid_and_electrolyte_imbalance_0.ppt
fluid_and_electrolyte_imbalance_0.ppt
 

Último

Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...chandars293
 
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...astropune
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls JaipurRussian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipurparulsinha
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableNehru place Escorts
 
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...Taniya Sharma
 
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...indiancallgirl4rent
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...CALL GIRLS
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...chandars293
 
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...jageshsingh5554
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Dipal Arora
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...Taniya Sharma
 
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore EscortsCall Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escortsvidya singh
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Call Girls in Nagpur High Profile
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...Arohi Goyal
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...narwatsonia7
 

Último (20)

Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
 
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
 
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls JaipurRussian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
Russian Call Girls in Jaipur Riya WhatsApp ❤8445551418 VIP Call Girls Jaipur
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
 
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
 
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
 
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
 
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore EscortsCall Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
 

Dka jason

  • 1. DIABETIC KETOACIDOSIS- DIAGNOSIS AND MANAGEMENT jason zachariah
  • 2. WHEN TO SUSPECT DKA?  Altered consciousness is the most common cause for seeking medical attention. It may range from mild disorientation to frank coma.  Insidious increased thirst and urination are common early symptoms.  Nausea and vomiting, diffuse abdominal pain.  Generalized weakness and fatiguability.
  • 3.  Symptoms of possible intercurrent infection- fever, dysuria, malaise and arthralgia  History of rapid weight loss is a symptom in patients who are newly diagnosed with type 1 diabetes
  • 4. PHYSICAL FINDINGS  Signs of dehydration- weak and rapid pulse, dry tongue and skin, hypotension, and increased capillary filling time.  Odour of breath: characteristic acetone odour  Signs of acidosis: kussmaul or sighing respiration, abdominal tenderness, and altered sensorium
  • 5. Signs of intercurrent illnesses: MI, UTI, pneumonia and perinephric abscess.
  • 6.
  • 7. CARDINAL BIOCHEMICAL FEATURES  Hyperglycemia >250mg/dl  Hyperketonemia  Metabolic acidosis- pH<7.3, HCO3 <15meq/L
  • 8. INVESTIGATIONS:  Venous blood: glucose, urea, electrolytes- (Na,K,HCO3)  Arterial blood gases  Urine-ketone bodies  Infection screen- CBP, blood and urine culture, C-reactive protein, Chest Xray
  • 9. URINE  Highly positive for glucose and ketones. Rarely ketones may test negative in urine, because laboratory tests can detect only acetoacetate, while predominant ketone in severe untreated DKA is beta hydroxybutyrate. As clinical condition improves, it tests positive because of its breakdown to acetoacetate.
  • 10. BLOOD AND PLASMA  Glucose: may be as low as 250 mg/dL to as high as more than 800 mg/DL  Sodium: The osmotic effect of hyperglycemia moves extracellular water to intravascular space. For each 100mg/dL of glucose over 100mg/dL, the serum sodium is lowered by approximately 1.6 mEq/L. When the glucose level falls, serum sodium will rise.- pseudohyponatremia
  • 11. BLOOD (CONT’D)  Potassium: elevated H+ drives the intracellular potassium to extracellular compartment and secondary aldosteronism drives the K+ cells from the kidney into urine.  Serum potassium levels do not reflect the state of total body potassium.
  • 12. BLOOD (CONT’D)  Bicarbonate: used in conjunction with anion gap to assess degree of acidosis  CBC- high WBC counts>15000 or marked left shift suggests underlying bacterial infection  ABG: pH<7.3
  • 13. BLOOD (CONT’D)  Osmolarity: =2(Na+)meq/L + glucose mg/dL +BUN mg/dL by 4 Usually >330 mOsm/kg H20. If osmolarity is less than this in a comatose patient, search for another cause of obtundation  Phosphorus: phosphate levels  High anion gap a usual finding. Anion gap= Na-(Cl+HCO3)
  • 14. OTHER TESTS  Ecg- DKA maybe precipitated by a cardiac event  Chest Xray- to rule out pulmonary infection
  • 15. MONITORING  Repeated monitoring of biochemistry is critical. Potassium needs to be checked every 1 to 2 hours during initial treatment. Glucose and other electrolytes should be checked every 2 hours or so.
  • 16.
  • 17. DIFFERENTIAL DIAGNOSIS  Lactic acidosis- serum glucose,ketones nl, lactate>5mm  Saturation ketosis: urine ketone +ve, blood ketone –ve, arterial pH usually normal  Alcoholic ketoacidosis: history of alcohol being main energy source for few days, strip test often -ve, normoglycemia or hypoglycemia common
  • 18. DIFFERENTIAL DIAGNOSIS  Uremic acidosis- normoglycemia  Rhabdomyolysis: increased CPK  Salicylate toxicity: normoglycemia, ketones negative