CLINICAL CASE 50: Answers and Summary

WHICH OF THE FOLLOWING ARE POTENTIAL CAUSES OF DEATH IN DIABETIC KETOACIDOSIS(DKA?)

Hyperkalemia	11 (15%)
Aspiration	1 (1%)
Hypokalemia	17 (23%)
Relative hypoglycemia	2 (2%)
Underlying lesion and complications	1 (1%)
All of the above	40 (55%)

Diabetic Ketoacidosis is a common entity that we encounter often leading to ICU level of care.  Standard treatment is usually volume expansion, insulin to stop ketoacid production.  As you give therapy with fluids and insulin, plasma glucose will fall, HCO3 will rise but slowly, ketoacids will decline, anion gap will close, plasma K will decrease, Na will increase and Phos will decrease. 

The five big reasons of complications in treatment of DKA are hyperkalemia that is present during admission and if not treated right away with insulin.  Due to the coma state sometimes, aspiration is likely.  As one starts treating, the K will drop and replacement with IV KCL is important.  6-8 hours later, relative hypoglycemia is also a major contributor and finally making sure the underlying cause of going into DKA is found and treated:- infection perhaps or whatever it might be. So all of the above is the correct answer.

For a good review on this topic: please read the short book:

The ACID Truth and BASIC facts with a SWEET touch, and enLYTEnment by Mitch Halperin, MD
by Rossmark Medical Publishers, 2004, Ontario, Canada.