DM DKA-1 - Hyperglycemic Emergencies DKA/HONC William...

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Hyperglycemic Emergencies DKA/HONC William Harper, MD, FRCPC Assistant Professor of Medicine, McMaster University
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DKA A collection of severe and potentially life- threatening metabolic disturbances: Hyperglycemia Osmotic diuresis » » ECFv contraction » Depletion of total body K + stores (even though may be hyperkalemic 2° to cell shift) Ketone production Metabolic acidosis » Compensatory Respiratory alkalosis (hopefully!) Uncontrolled lipolysis severe TG
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DKA physiology: Insulin & Lipids
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DKA: Pathophysiology Glucose Pyruvate Acetyl-CoA Ketoacids Kreb’s + PFK Insulin fat cell TG FFA HSL Liver Cell Fatty Acyl-CoA Insulin - VLDL (TG) Glucagon Insulin + +
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DKA: Pathophysiology Glucose Pyruvate Acetyl-CoA Ketoacids Kreb’s + PFK Insulin fat cell TG FFA HSL Liver Cell Fatty Acyl-CoA Insulin - VLDL (TG) Glucagon Insulin + +
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DKA risk factors T1DM 1 st presentation Acute-illness Insulin omission (inappropriate sick-day management, noncompliance, Eating Disorders) T2DM During stress Ethnicity: African-American, Hispanic Extremes of age Poor glycemic control MDI with CSII
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DKA: Precipitating Factors Acute illness (MI, GIB, trauma, pancreatitis) New-onset DM Insulin omission Infections 10-20% 5-39% 33% 20-38%
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DKA: Diagnosis : Polyuria, polydipsia, weight-loss Fatigue N/V, abdominal pain 2200 ECFv, Kussmaul’s, Acetone breath, mild impairment in cognition Laboratory : pH < 7.3, serum HCO3 < 15 mEq/L, AG > 14 mM Raised serum ketones (and urine ketones) BS > 14 mM (occasionally normal or only mild BS)
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DM DKA-1 - Hyperglycemic Emergencies DKA/HONC William...

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