Diabetic Ketoacidosis Management Flashcards
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A patient with DKA has a serum osmolality of 340 mOsm/kg and an altered mental status. What additional diagnosis should be considered?
Answer: Overlapping hyperosmolar hyperglycemic state (mixed DKA/HHS)
Serum osmolality >320 mOsm/kg with DKA criteria suggests a mixed DKA/HHS state, which requires attention to osmolarity during fluid replacement.
Which of the following is the most common electrolyte abnormality requiring monitoring after DKA resolution?
Answer: Hypokalemia
As insulin drives potassium intracellularly and urinary losses are repleted slowly, hypokalemia is the most common electrolyte complication after DKA treatment.
A patient with DKA secondary to new-onset type 1 diabetes is being discharged. Which statement about follow-up insulin management is most accurate?
Answer: Both basal and prandial insulin regimens should be established prior to discharge
Patients with new-onset type 1 diabetes should be discharged on a basal-bolus insulin regimen with diabetes education and close follow-up.
Which arterial blood gas pattern is most consistent with DKA with appropriate respiratory compensation?
Answer: pH 7.22, PaCO2 28, HCO3 11
DKA causes metabolic acidosis with respiratory compensation (Kussmaul breathing lowers PaCO2); the expected PaCO2 = 1.5 × HCO3 + 8 ± 2.
An elderly patient with DKA develops oliguria despite 3 liters of IV fluids. Creatinine rises from 1.2 to 3.8 mg/dL. What complication has occurred?
Answer: Acute kidney injury from hypovolemia and hypoperfusion
Severe dehydration and hypoperfusion in DKA commonly cause prerenal or intrinsic acute kidney injury, which may not reverse promptly with fluid resuscitation.
Which of the following triggers is most classically associated with DKA in a previously well-controlled type 1 diabetic who is NOT missing insulin doses?
Answer: Occult infection (e.g., UTI, pneumonia)
Infection is the most common medical precipitant of DKA in compliant type 1 diabetic patients, as counter-regulatory hormones from illness increase insulin resistance.
Which clinical finding is characteristic of Kussmaul respirations in DKA?
Answer: Deep, slow, labored breathing as respiratory compensation for acidosis
Kussmaul respirations are deep, slow, and labored — a compensatory response to metabolic acidosis that lowers PaCO2 to raise pH.