1. Endocrine Emergencies Professor Ikram S Ismail PhD (Wales) FRCP (Edin) FAMM FACE

7. DKA: Pathophysiology

8. DKA: Pathophysiology

10. DKA - Signs Dehydration Osmotic Diuresis, vomiting Tachycardia Dehydration Hypotension Dehydration, acidosis Warm skin Acidosis (peripheral vasodilatation) Hyperventilation Ketosis, acidosis Coma, drowsiness Hyperosmolality

13. Established DKA >3.0 If concurrent stress and poor compliance - admit >1.5 Retest glucose and ketones in 2-4hrs 0.6 – 1.5 Check clinical status <0.6

14. DKA – Investigations Hyperglycaemia, hyperketonaemia Insulin deficiency Decreased pH, PCO2, bicarbonate Increased ketogenesis Hyponatraemia Hyperglycaemia Variable K Insulin deficiency, acidosis, urine loss Raised WCC Hyperketonaemia Raised haematocrit Dehydration

15. DKA - Deficits Water 5 to 8 liters Sodium 400-700 mmol Chloride 300-500 mmol Potassium 300-1000 mmol Calcium 100 mmol Magnesium 50 mmol Phosphate 50 mmol Bicarbonate 350 to 400 mmol

28. Hypoglycaemia : Symptoms and Signs