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Diabetic Emergencies, Diagnosis and Clinical Management: Diabetic Ketoacidosis in Adults, 5 Quiz Questions

Mar 25, 2013
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This week we have a short quiz. If you’ like to review the topic a little more before taking the quiz, just follow this link to our previous excerpt at Diabetic Emergencies – Diagnosis and Clinical Management: Diabetic Ketoacidosis in Adults.
 

 
The pathogenesis of hyperglycemia in diabetic ketoacidosis includes all the following mechanisms except for:

a. Increased glycogenolysis in the liver

b. Increased gluconeogenesis in the kidneys

c. Increased serum glucagon

d. Increased gluconeogenesis in adipose tissue

e. Decreased glucose uptake from the muscles

 

Which of the following symptoms/signs are included in the clinical features of diabetic ketoacidosis?

a. Polyuria and weight loss

b. Tachypnea and tachycardia

c. Abdominal pain and vomiting

d. Cheyne-Stokes respiration

e. All of the above

f. a + b + c
 
A male with severe diabetic ketoacidosis is admitted to the hospital. Which of the following are his biochemical test results? 

a. pH 7.21, PCO 2 27 mmHg, Ht 49%, glucose 490 mg/dl (27.2 mmol/L)

b. Ht 53%, HCO 3-15 mEq/L, K+ 4.8 mEq/L, glucose 400 mg/dl (22.2 mmol/L)

c. PCO 2 17 mmHg, pH 6.95, K+ 3.9, HCO 3-8 mEq/L, glucose 490 mg/dl (27.2 mmol/L)

d. pH 7.0, PO 2 109 mmHg, Na+ 143 mEq/L, glucose 150 mg/dl (8.3 mmol/L)

e. Glucose 880 mg/dl (48.9 mmol/L), white blood cell count 26,000/ μ l, Na+ 159 mEq/L, HCO

 3-28 mEq/L
 
 
A 35-year-old female with diabetic ketoacidosis is admitted to the hospital with the following profile: serum glucose 412 mg/dl (22.9 mmol/L), pH 7.12, K+ 4.4 mEq/L, Na+ 141 mEq/L, and PO 4 3-2.4 mEq/L (0.77 mmol/L). Which of the following is the appropriate initial treatment?
 

a. Administration of hypotonic sodium chloride (0.45%) solution, potassium, and insulin

b. Administration of normal saline and insulin

c. Administration of normal saline, potassium, and insulin

d. Administration of normal saline, potassium, insulin, and bicarbonates

e. Administration of normal saline, insulin, and phosphate

 
Which of the following sentences about diabetic ketoacidosis is correct? 

a. Administration of glucose 5% solution is prohibited

b. Insulin can be administered subcutaneously in all cases of diabetic ketoacidosis

c. Blood glucose should be measured every 3 hours after initiation of treatment

d. All of the above

e. None of the above

Answers: 1-d, 2-f, 3-c, 4-c, 5-e
 
References
  1. Ioannidis I. Diabetic coma. In: Katsilambros N, Diakoumopoulou E, Ioannidis I, Liatis S, Makrilakis K, Tentolouris N, Tsapogas P (ed), Diabetic ketoacidosis in adults 31 Diabetes in Clinical Practice, Questions and Answers from Case Studies, West Sussex, England: John Wiley & Sons Ltd, 2006: 81-91.
  2. Umpierrez GE, Smiley D, Kitabchi AE. Narrative review: ketosis-prone type 2 diabetes mellitus. Ann Intern Med 2006; 144: 350-7.
  3. Faich GA, Fishbein HA, Ellis SE. The epidemiology of diabetic acidosis: a population-based study Am J Epidemiol 1983; 117: 551-8.
  4. Katsilambros N. Epidemiology of acute manifestations and complications. In: Williams R, Papoz L, Fuller J (ed), Diabetes in Europe, A Monograph on Diabetes Epidemiology in Europe produced as part of the ‘Eurodiab’ Concerted Action Programme of the European Community, London, UK: John Libbey & Company Ltd, 1994: 39-209.
  5. Ellemann K, Soerensen JN, Pedersen L, Edsberg B, Andersen O. Epidemiology and treatment of diabetic ketoacidosis in a community population. Diabetes Care 1984; 7: 528-32.
  6. Wyckoff J, Abrahamson MJ. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. In: Kahn R, King GL, Moses AC, Weir GC, Jacobson AM, Smith RJ (ed), Joslin’ s Diabetes Mellitus, 14th edn, Philadelphia, USA: Lippincott Williams & Wilkins, 2005: 887-99.
  7. Javor KA, Kotsanos JG, McDonald RC, Baron AD, Kesterson JG, Tierney WM. Diabetic ketoacidosis charges relative to medical charges of adult patients with Type I diabetes. Diabetes Care 1997; 20: 349-54.
  8. Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, Wall BM. Management of hyperglycemic crises in patients with diabetes. Diabetes Care 2001: 24: 131-53.
  9. Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 2009; 32: 1335-43.
  10. Krentz AJ, Nattrass M. Acute metabolic complications of diabetes: diabetic ketoacidosis, hyperosmolar non-ketotic hyperglycemia and lactic acidosis. In: Pickup JC, Williams G (ed), Textbook of Diabetes Mellitus, 3rd edn, Oxford, UK: Blackwell Publishing, 2003: 32. 1-24.
  11. Maldonado M, Hampe CS, Gaur LK, et al. Ketosis-prone diabetes: dissection of a heterogeneous syndrome using an immunogenetic and beta-cell functional classifi cation, prospective analysis, and clinical outcomes. J Clin Endocrinol Metab 2003; 88: 5090-8.
  12. Balasubramanyam A, Nalini R, Hampe CS, Maldonado M. Syndromes of ketosis-prone diabetes mellitus. Endocr Rev 2008; 29: 292-302.
  13. Umpierrez, GE. Ketosis-prone type 2 diabetes: time to revise the classify cation of diabetes. Diabetes Care 2006; 29: 2755-7.
  14. Newton CA, Raskin P. Diabetic ketoacidosis in Type 1 and Type 2 diabetes mellitus. Arch Intern Med 2004; 164: 1925-31.
  15. Pinero-Pilona A, Raskin P. Idiopathic Type 1 diabetes. J Diabetes Complications 2001; 15: 328-35.
 

Nikolaos Katsilambros, MD, PhD, FACP
SCOPE Founding Fellow
Professor of Internal Medicine
Athens University Medical School
Evgenideion Hospital and Research Laboratory ‘Christeas Hall’
Athens, Greece
Christina Kanaka-Gantenbein, MD, PhD
Associate Professor of Pediatric Endocrinology and Diabetology
First Department of Pediatrics, University of Athens
Agia Sofia Children’s Hospital
Athens, Greece
Stavros Liatis, MD
Consultant in Internal Medicine and Diabetology
Laiko General Hospital
Konstantinos Makrilakis, MD, MPH, PhD
Assistant Professor of Internal Medicine and Diabetology
Athens University Medical School
Laiko General Hospital
Athens, Greece
Nikolaos Tentolouris, MD, PhD
Assistant Professor of Internal Medicine and Diabetology
University of Athens
Laiko General Hospital
Athens, Greece
 
A John Wiley & Sons, Ltd., Publication This edition first published 2011 © 2011 by John Wiley & Sons, Ltd.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient.
 
Diabetic Emergencies: Diagnosis and Clinical Management provides emergency room staff, diabetes specialists and endocrinologists with highly practical, clear-cut clinical guidance on both the presentation of serious diabetic emergencies like ketoacidosis, hyperosmolar coma and severe hyper- and hypoglycemia, and the best methods of both managing the emergencies and administering appropriate follow-up care.
 
For more information and to purchase this book, just follow this link: Diabetic Emergencies: Diagnosis and Clinical Management 

 

     
     
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