USMLE/COMLEX - Step 2 - Diabetic Ketoacidosis

DKA is caused by insulin deficiency, leading to increased glucose production by the liver, breakdown of fat for energy, and accumulation of ketones, resulting in acidosis and electrolyte imbalances. Excessive thirst and urination Rapid breathing Fruity-smelling breath Confusion or altered mental status High blood glucose levels Elevated blood glucose levels above 250 mg/dL Low blood pH levels below 7.3 Elevated ketone levels in the blood and urine Electrolyte imbalances, particularly low levels of potassium and sodium Signs of dehydration include dry mouth, sunken eyes, and decreased skin turgor. Blood glucose level ABG Ketone test Serum electrolytes Urinalysis The treatment of DKA involves several steps to correct the underlying metabolic abnormalities and prevent complications. These steps include: 1. Fluid replacement: Intravenous fluids are given to restore the body's water balance and correct dehydration. Normal saline is the preferred fluid for initial resuscitation. 2. Insulin therapy: Insulin is given to lower blood glucose levels and halt the production of ketones. It is usually given as an intravenous infusion initially and later switched to subcutaneous injections. 3. Electrolyte replacement: Electrolyte imbalances, particularly low potassium and sodium levels, are common in DKA and must be corrected. 4. Treatment of underlying causes: Any underlying infection, illness, or other conditions contributing to DKA should be treated promptly. 5. Monitoring: Vital signs, blood glucose, electrolyte levels, and acid-base status should be closely monitored during treatment.