This document discusses diabetic ketoacidosis (DKA) in a 21-year-old woman. DKA is diagnosed based on symptoms like thirst, frequent urination, weakness, nausea and vomiting. Precipitating factors include missed insulin doses and underlying infections. Treatment involves fluid replacement, insulin administration, and monitoring of metabolic parameters to correct dehydration, hyperglycemia and electrolyte imbalances. Complications can include cerebral edema, hypokalemia and death if treatment is not properly administered.

1. SPMP ON DIABETIC KETOSIS Dr. S. Aswini Kumar.MD. A 21 year-old woman is brought to the Accident & Emergency Department having been generally unwell for 2 weeks VII. 01. Diagnosis of DKA can be suspected from the following EXCEPT: Thirst, polyuria, polydypsia and nocturia General weakness, malaise and lethargy Nausea, vomiting and abdominal pain Increased sweating, palpitation and giddiness Symptoms of associated infections VII. 02. Following signs are helpful in the diagnosis of DKA, EXCEPT: Emaciated patient with an ill look Dry skin, mucus membrane and increased skin turgor Patient remaining fully conscious throughout Tachycardia, tachypnoea, and hypotension Breath which has fruity smell of acetone VII. 03. Various precipitating factors for DKA are the following EXCEPT: Missed insulin treatment Underlying infection Newly diagnosed, Type 2 DM Stress situations like Trauma, Surgery or MI Failure to appreciate symptoms of poor control of DM VII. 04. The immediate differential diagnosis to be considered is: Hyper Osmolar Non Ketotic Coma Acute hypoglycemia Alcoholic ketoacidosis Acute appendicitis All of the above VII. 05. Following are in accordance with the diagnosis of DKA EXCEPT: Glycosuria Ketonuria Hyperglycemia Hypernatremia Increased serum bicarbonate level VII. 06. The general measures useful in the treatment of DKA are the following EXCEPT: Feeding by mouth for at least six hours Insertion of a nasogastric tube Insertion of an indwelling catheter Insertion of a central line Arterial line to monitor ABGs VII. 07. The components of treatment are the following EXCEPT: The administration of modified insulin Fluid replacement Potassium replacement The administration of antibiotics Constant monitoring of metabolic parameters VII. 08. The following statement about IV fluids in DKA is NOT TRUE: It is a must since oral fluids may be poorly absorbed. Or else insulin will not reach poorly perfused tissues. Average fluid deficit is 6 liters; 1 liter is from intracellular compartment Caution in patients with compromised CVS VII. 09. The deficit of extra-cellular fluid must be made good by infusing: 0.9% isotonic saline 5.0% Dextrose saline Ringer lactate solution 5.0% Dextrose solution 20% Mannitol solution VII. 10. The blood sugar level at which the saline infusion is to be substituted with 5% Dextrose saline is 550mg% 450mg% 350mg% 250mg% 150mg% VII. (11). Following modes of insulin administration are acceptable EXCEPT: A. Loading dose of 10-20 units of regular insulin IM. B. 4 units of regular insulin hourly thereafter by SC C. Insulin infusion preferably using infusion pump D. If no fall in RBS by 2 hours IV insulin is doubled E. When RBS is 250 mg, insulin is to 2-4 units/hr VII. (12). The following statements regarding the administration of potassium are true EXCEPT: A. Total K+deficit is 1-2meq/kg irrespective of initial levels B. If initial S K+ is <3.3 meq administer K+ before insulin C. If S K+ <3.3meq/L give 40 meq of K+ till it is 3.3meq/L D. If S K+ <3.3-5.5 give 20 meq of K+ in anticipation E. If S K+ >5.5 with hold K+ and monitor K+ every 2hours VII. (13). The following statements about bicarbonate are true, EXCEPT: A. In severe acidosis give sodium bicarbonate (1.4%) B. Correction of total bicarbonate deficit not attempted C. Rapid correction may aggravate tissue hypoxia D. It may cause a paradoxical acidosis of CSF E. Bicarbonate + insulin risk of Hyperkalemia VII. (14). Findings suggestive of poor prognosis in DKA include the following EXCEPT: A. Impaired consciousness level B. pH less than 7.0 C. Oliguria D. Low potassium at presentation E. Anion gap less than 10 VII. (15). The causes of death in DKA are the following EXCEPT: A. Hyperkalemia B. Hypokalemic respiratory arrest C. Aspiration due to gastric stasis D. Cerebral edema due to acidosis E. Overhydration VII. (16). The following facts are true regarding cerebral edema due to treatment are true EXCEPT: A. Develops more commonly in patients <20 years B. Serum osmolality ↓ by more than 3mOsm/kg/h C. IV mannitol is found to be beneficial in such cases. D. The dose of mannitol is 0.25-1.0g/kg in 20 minutes E. Hypertonic saline can be used alternatevly VII. (17). The following additional treatment is essential EXCEPT: A. IV line with cannula or large bore needle B. Catheterization after 3 hours if no urine is passed. C. RBS & electrolytes hourly X3h and then 4 hourly. D. Nasogastric tube to feed the patient E. CVP line if CVS is compromised