Diabetic Ketoacidosis. Michele Ritter, M.D. Argy Resident – February, 2007. Diabetic Ketoacidosis (DKA).
Michele Ritter, M.D.
Argy Resident – February, 2007
Anion gap = (Na+) – (Cl- + HCO3-)
Pseudohyponatremia: to correct, add 1.6 mEq of sodium to every 100mg/dL of glucose above normal
Positive in DKA; Possibly small in HNS
Ketones (for DKA); leukocyte esterase, WBC (for UTI)
Leukocytosis (possible infection)
To evaluate for pancreatitis
BUT, DKA by itself can also increase them!
Evaluate for possible MIDiagnostic Studies in DKA/HHS
Leuk. Est: 4 +
WBC > 50Case # 1 (cont.)
(A) She was given too much potassium chloride and had suppression of all cardiac pacemaker activity.
(B) She was given too little potassium chloride and developed respiratory muscle paralysis followed by ventricular fibrillation.
(C) She was given too little insulin in the face of an unusually high plasma glucose concentration and developed cerebral edema.
(D) She was given too much bicarbonate, which led to cerebrospinal fluid acidosis and suppression of the brain stem respiratory center.
(E) She should have been given her potassium as potassium phosphate in order to prevent respiratory muscle paralysis from hypophosphatemia caused by insulin administration.