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DKA and HHS: Definitions and Management

The document outlines the definitions and clinical features of Hyperglycemic Hyperosmolar State (HHS) and Diabetic Ketoacidosis (DKA), highlighting their distinct presentations and symptoms. It details the necessary investigations and treatment regimens for DKA, including fluid management, insulin administration, potassium supplementation, and monitoring protocols. The document emphasizes the importance of careful management and monitoring in the treatment of these conditions.

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4 views4 pages

DKA and HHS: Definitions and Management

The document outlines the definitions and clinical features of Hyperglycemic Hyperosmolar State (HHS) and Diabetic Ketoacidosis (DKA), highlighting their distinct presentations and symptoms. It details the necessary investigations and treatment regimens for DKA, including fluid management, insulin administration, potassium supplementation, and monitoring protocols. The document emphasizes the importance of careful management and monitoring in the treatment of these conditions.

Uploaded by

ilkelambrechts101
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

DKA & HHS

Definitions
HHS: Extreme hyperglycaemia w/o ketoacidosis, but with hyperosmolar state and altered
mental status in type 2 diabetics. Usually hyperglycaemia  osmotic diuresis 
dehydration  more hyperglycaemia
DKA: Triad of hyperglycaemia, metabolic acidosis, and ketosis. Occurs mostly in type 1
Diabetics. Hyperglycaemia develops from decreased glucose uptake into the cells,
increased gluconeogenesis. Ketosis develops because of inability to use glucose 
mobilization and oxidation of fatty acids and increased ketogenic state of the liver with
decreased ketone clearance

1
Clinical features
 HHS
o Subacute (longer than acute) presentation of:
 Polyuria
 Polydipsia
 Weight loss
o Signs
 Volume depletion (dehydration)
 Low skin turgor
 Hypotensive
 Tachycardia
 Dry mucous membranes
 Altered mental state
  Glucose

 DKA
o Acute presentation (24h) of:
 Polyuria
 Polydipsia
 N&V
 Abdominal pain
o Signs
 Hyperventilation 2o to metabolic acidosis  Kussmaul breathing
 Acetone odour
 Volume depletion (dehydration)
 Low skin turgor
 Hypotensive
 Tachycardia
 Dry mucous membranes
 Eventually +/- Altered mental state (acutely confused)
  Glucose

Investigations (NB)
Hyperglycaemia and hyperosmolarity
I. ABG
a. K, Bicarb, pH
II. Urine
a. Glucose/ketones
III. Blood
a. BG, U&E, creatinine, phosphate, ketones

2
DKA regimen (NB)

To be started after initial fluid resuscitation

A. FLUIDS: (USE DIAL-A-FLOW)


a. Type
i. 0.9% NaCl ( in corrected Na)
ii. 0.45 NaCl (if  in corrected Na)
iii. 5% Dextrose  If glucose </= 14 or s-Na > 150

B. INSULIN: (ALWAYS USE IN IVAC)


a. 20U ACTRAPID in 200ml 0.9% NaCl = 0.1 U/ml
i. Dose = 0.1U/kg/h = 1ml/kg/h
ii. E.g. 1 ml x 80kg = 80ml/h through IVAC
b. Chart BG hourly until </= 14 mmol/L then 2 hourly
Finger prick glucose Adjust IV Actrapid
< 5.6  by 10ml/h and give 25ml 50% Dextrose
5.6 - 8.9  by 10ml/h
9 - 12.2 No change
12.3 - 15.6  by 10ml/h
> 15.6  by 10ml/h and give 8U Actrapid IV bolus

3
c. Chart urine ketones 4 hourly

C. POTASSIUM
Add X mmol KCl in each vaculitre according to K level
Blood K mmol/L KCl per litre fluid
</= 3 40
3.1 - 4 30
4.1 - 5 20
5.1 - 5.5 10
> 5.5 Omit

NEVER give > 20 mmol KCl per hour IV


D. Other
a. STRICT intake and output and monitoring

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