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Diabetic Ketoacidosis and HHS Flashcards

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  1. A patient with DKA has a serum potassium of 5.8 mEq/L on presentation. When should potassium supplementation be initiated?

    Answer: When potassium falls below 5.5 mEq/L

    Potassium supplementation should be added to IV fluids when serum K+ falls below 5.5 mEq/L to prevent hypokalemia from insulin-driven cellular uptake.

  2. Which of the following best explains the mechanism of anion gap metabolic acidosis in DKA?

    Answer: Accumulation of beta-hydroxybutyrate and acetoacetate

    DKA causes anion gap acidosis due to accumulation of ketoacids (beta-hydroxybutyrate and acetoacetate) from unregulated fatty acid oxidation.

  3. A 28-year-old with type 1 DM presents with DKA. Blood glucose is 420 mg/dL and beta-hydroxybutyrate is elevated. After 8 hours of treatment, glucose is 180 mg/dL but pH remains 7.15 and anion gap is still elevated. What is the most appropriate next step?

    Answer: Add dextrose to IV fluids and continue insulin

    When glucose falls below 200-250 mg/dL before anion gap closes, dextrose should be added to IV fluids to allow continuation of insulin until ketoacidosis resolves.

  4. What is the most common precipitating factor for DKA in patients with established type 1 diabetes?

    Answer: Insulin omission

    Insulin omission (non-adherence) is the most common precipitating cause of DKA in patients with known type 1 diabetes.

  5. A patient with HHS has a serum osmolality of 345 mOsm/kg and blood glucose of 1100 mg/dL. Which IV fluid is most appropriate for initial resuscitation?

    Answer: 0.9% NaCl (isotonic saline)

    Isotonic normal saline (0.9% NaCl) is used first in HHS to restore circulating volume before transitioning to hypotonic fluids for free water replacement.

  6. Which laboratory finding would most strongly suggest HHS rather than DKA in a hyperglycemic patient?

    Answer: Absence of significant ketonemia with pH > 7.3

    The hallmark distinguishing feature of HHS from DKA is the absence of significant ketoacidosis (pH > 7.3, bicarbonate > 18 mEq/L, minimal ketonemia).

  7. A patient recovering from DKA develops worsening headache, confusion, and pupillary changes 6 hours into treatment. What is the most likely diagnosis?

    Answer: Cerebral edema

    Cerebral edema is a life-threatening complication of DKA treatment, most common in children, caused by rapid fluid shifts and osmotic changes during correction.