DIABETIC KETOACIDOSIS_Clinical features and Management

Posted by e-Medical PPT Tuesday, September 11, 2012
Clinical features
Common cause of death in type 1 diabetics
Can occur in type 2 as well
Hyperketonemia/significant ketosis
Metabolic acidosis
Hyperglycemia
Patient factors: infection, inadequate insulinization, stress, MI, new cases

Symptoms
Polyuria, nocturia, thirst
Rapid weight loss
Muscular weakness
Visual disturbance
Air hunger
Abdominal pain, nausea, vomiting
Leg cramps
Altered sensorium

Signs
Acetone breath
Air hunger
Impaired consciousness
Hyperglycemia, osmolarity
Cerebral edema if sensorium worsens during treatment
Hypotension: due to peripheral vasodilatation due to acidosis
Hypothermia
Succussion splash
May mimic surgical emergency

D/D
Hyperosmolar non-ketotic coma
Hypoglycemia
Lactic acidosis
Associated CNS pathology
Other metabolic encephalopathies
Acute pancreatitis

Cardinal principles
Replace insulin
Replace fluids
Correct electrolytes
Treat the cause
Supportive treatment
Prevent complications

Complications
Cerebral edema
ARDS
Thromboembolism
DIC
Rhinocerebral mucormycosis
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