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Pathology
Insulinopaenia causing diversion of metabolism to use alternate fuel. Also see pathology of diabetes above.
Aetiology
First presentation of Type1Diabetes Mellitus or in pre-existing diabetes from insulin omission/failed therapy or intercurrent infection.
Signs
Dehydration “pear drop” smell on breath, tachypnoea, Kussmaul’s breathing, drowsiness, coma, hypotension.
Symptoms
Polyuria, polydipsia, weight loss, nausea, vomiting, lethargy, abdominal pain, headache
Investigations
Bloods: FBC, U&Es, LFTs, ketones and Glucose (>11mmol/L)
Venous Blood Gas: Blood PH≤7.3, Venous HCO3≤15
ECG: Rule out ischaemia or infarction
MSU: Screen for infection and screen for ketones
Chest X-Ray: Screen for infection
CT Head: if prolonged low GCS
Treatment
DKA protocol Fixed rate IV insulin at 0.1 units/Kg/Hr, IV fluids 4-6 litres/24
hours with 1st two litres over 3 hours, potassium monitoring and
replacement, and treatment of any intercurrent infections
Resolution criteria: Venous PH>7.35, HCO3>18, and serum ketones <0.3
mmol/L)
Prognosis
As above, usually good if recognised and treated appropriately
Mortality 2-5% (up to 50% in elderly). More commonly causes increased morbidity
Key Facts
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Key Images
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Key References
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