Case Study: DKA
1. A 24-year-old woman presents to the Emergency Room with nausea and
vomiting. Her pulse rate is 110 and her blood pressure is 90/60. She has mild
abdominal tenderness. Laboratory tests include sodium 132, potassium 4.0,
chloride 96, and CO2 6. Glucose is 540, BUN is 24, Creatinine is 0.6. She
weighs 70 kg.
(A) Does this patient have metabolic acidosis?
(B) Does this patient have potassium deficiency?
(C) Does this patient have volume contraction?
2. Calculate the total volume deficiency, the sodium deficiency, and the potassium
deficiency. Devise a strategy for replacing the potassium deficiency over the next
two days.
3. Make a reasonable estimate about the expected insulin requirements over the next
24 hours.
4. During the first four hours the glucose level dropped by more than 100 mg/dl per
hour. Does the rapidity in change represent any concern?
5. Patients with DKA have very severe insulin deficiency. Consequently they will
need insulin around the clock after you stop the IV insulin drip. Provide a plan
for ordering insulin.
6. What are the most common causes of DKA in a patient with established diabetes?