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let me just get a few things straight in managing DKA
1. Hypovolemic shock kills patient first
2. Then K derrangement
3. only then acidosis
1. Hypovolemic shock kills patient first
2. Then K derrangement
3. only then acidosis
Fluid resus is key. a lot of people cant wait to start insulin. they think insulin is the star here. no its fluid!
Remember, before we start insulin, always check potassium first. if K <3.3, DO NOT start insulin. pt will go to hypokalemia, then VT then VF then die
im sure different centre have different protocols, but heres mine:
K >5.3: can start insulin, no need K correction
K 3.3-5.3 : correct K 1g over 4 H, can start insulin
K <3.3 : do not start insulin. correct K 2g in 200cc over 2H
K >5.3: can start insulin, no need K correction
K 3.3-5.3 : correct K 1g over 4 H, can start insulin
K <3.3 : do not start insulin. correct K 2g in 200cc over 2H
If blood sugar <14, start D10% 75mls/h (if D5% then run 125mls/h), why? because we need to maintain blood sugar at a certain level when we start insulin.
so what is the main role of insulin in DKA mx actually? to brings down sugar level? NO
It is prevent ketone formation
But why r we scared of ketone?? because ketone contributes to acidosis. acidosis cause enzymes to malfunction.
It is prevent ketone formation
But why r we scared of ketone?? because ketone contributes to acidosis. acidosis cause enzymes to malfunction.
mind you pH <6.9 cause all enzyme activity to stop and patient can die. Thats why we need insulin to prevent this. But like i said, acidosis is the third in line to kill patient. Hypovolemic shock kill them first. So FLUID RESUS betul2 okay
talk about ketone, there are:
1. Betahydroxybutyric acid (BHB) - blood ketone
2. acetone
3 acetacetate - urine ketone
Blood ketone bnyk, and can be detected first. urine ketone takes time n lambat utk detect
1. Betahydroxybutyric acid (BHB) - blood ketone
2. acetone
3 acetacetate - urine ketone
Blood ketone bnyk, and can be detected first. urine ketone takes time n lambat utk detect
kalau u all suspect dka n urine ketone negative, jgn pegi minum kopi dulu. check blood ketone first. it happened to me once, and never again. i missed a dka patient because urine ketone negative =(
i forgot to explain how insulin can prevent ketone formation. insulin is lipid best friend. it prevents lipolysis. meaning it prevent breakdown of tryglyceride into FFA n subsequently ketones. gosh i really need to make a video to explain this better. i can lukis n show
