30 yrs female with pain abdomen, vomiting , breathlessness , RBS by Glucometer showing high, BP 130/90 ,. ECG & ABG enclosed.



Pt is having metabolic acidosis plus lactic acidosis with compensatory respiratory alkalosis. Send blood ketones, urine ketones. She is having dka. Ecg is showing tall t waves due to hyperkalemia. Rush I.v fluids, central line insertion, insulin infusion. Replace bicarbonate and give inj calcium glucobate for cardiac membrane stabilisation. Monitor urine output. Usg abd , urine routine and rft's to rule out aki vs diabetic nephropathy. CBC , lft, and cultures to rule out sepsis. May send amylase and lipase to rule out pancreatitis as well.

Thia is classical DKA with non compatable to life met acidosis so you secure large bore iv cath, you have to give bicarbonate (no other way ) start iv fluid 30ml/kg and 150 ml/hr, before starting fluid n bicarb collect blood sample send for Cbc,SE RFT, urine ketone urine glucose, blood sugar in lab, Start insuline drip with bolus of 0.1iu/kg n 0.5 iu/kg infusion if sugar drops below 250 mg/dl add D5% fluid ,lact 1.7 is not marker of latic acidosis it shoould be more than 2 then only we can say (lactate it is marker of hypoperfusion)

Dka versus lactic acidosis.. send serum lactate levels and urine ketones...severe metabolic acidosis that requires bicarbonate correction after calculating bicarb deficit, send serum lactate levels and hydrate the patient Hyponatremia and hyperkalemia require urgent correction. Tall t waves in ecg is due to hyperkalemia. Tachycardia is due to dehydration Check serum creat and bun: likely to be raised

Hyperglycaemia with diabetic keto acidosis


Case of DKA

Severe DKA

Case of uncontrolled DM with Diabetic ketoacidodsis ( metabolic acidosis) with compensatory Respiratory alkolosis with dyslectromia (hyperkalemia & hyponatremia , hypocalcemia) Rx. Inj regular insulin 40 unit in N. S 500ml stat . (for hyperglycemia &hypanatremia) Inj Ca.Gluconate stat ( for hyperkaemia) Tab tolvaptan(V2antagonist)- ( for evulomic hyponatremia ).... IvF NS infusion 1-2ml/kg/h.....for (hypovolemic)... Other investigation is also neccesary

DKA with Electrolytes imbalance.( Typical presentation)

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