DKAPPTx
DKAPPTx
DKAPPTx
HOPI
MY PT. IS A KNOWN CASE OF T1DM
FROM LAST 07 YEARS WHO IS ON
INSULIN
THERAPY…
SEQUENCE
• CASE HISTORY
• SEQUENCE OF EVENTS
• CASE DISCUSSION
PAST MED/SURG/DRUG HX
T1DM from last 07 years
FAMILY HX
Non-significant
PERSONAL HX
Non-significant
GENERAL PHYSICAL EXAMINATION
VITALS • Tachypnea
• Unconscious
BP 108/58mmHG • Acidotic breathing
PULSE 147/min
TEMP 98’F
CVS
S1 + S2 + 0
R/R 30/min
SP02 98%
CNS
Plantars
BSR 523mg/dl
SYSTEMIC REVIEW
GPE CVS
• Tachypnea S1 + S2 + 0
• Unconscious
• Acidotic breathing
CNS
ABDOMEN Plantars
• Soft + Tenderness on deep
palpation, No visceromegaly.
CHEST
• B/L Air entry
• B/L Vesicular Breathing
INVESTIGATIONS
URINE RE
Glucose Present (+++)
Urine for Ketone Bodies Present (+++)
DIAGNOSIS
DIABETIC KETOACIDOSIS
IMMEDIATE MANAGEMENT
• ABC Approach and 2 Wide-bore Cannula
• Fluids
• Insulin IV Infusion (FRII)
• Avoid Hypoglycemia
• LMWH
• Frequent Monitoring of CBG, Ketones, Serum K,
ABGs, and Urine Output
• Initiation of Insulin N and R administration
SEQUENCE OF EVENTS
• CVA
• Acute Myocardial Infarction
• Acute Pancreatitis
• Drugs
• Clozapine or olanzapine
• Cocaine
• Lithium
• SGLT2 inhibitors
• Terbutaline
PATHOPHYSIOLOGY