SAQ 124 – Metabolic – DKA and hyperosmolar non-ketotic state

Review Completed

Marked out of 12.00

Complete the table to distinguish between the investigative features of diabetic ketoacidosis and hyperosmolar non-ketotic state.

(Marked out of 4.0)

Investigation	Diabetic ketoacidosis	Hyperosmolar non-ketotic state
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/ 4

Complete the table to distinguish between the management of diabetic ketoacidosis and hyperosmolar non-ketotic state.

(Marked out of 8.0)

Key management step	Diabetic ketoacidosis	Hyperosmolar non-ketotic state
1.
2.
3.
4.

/ 8

Total Score: 0 / 12

Percentage: 0%

Investigation	Diabetic ketoacidosis	Hyperosmolar non-ketotic state
BSL	>11 mmol/L, rarely >30	Very high BSL, often >33
Osmolality	Normal	Hyperosmolar, >350 mOsm/L
Acidosis	pH <7.3 and HCO3 <15	Mild or absent; may have mild lactic acidosis
Serum ketones	>=0.6 mmol/L, usually >10 mmol/L	<=0.6 mmol/L
Urea:creatinine	May be increased	Increased

Key management step	Diabetic ketoacidosis	Hyperosmolar non-ketotic state
Fluid requirements	Around 5 L deficit, replaced over 24-48 hours	Greater volumes needed, 8-20 L, slow IV replacement over 48-72 hours
Insulin rate	Required at 0.1 IU/kg/hr if BGL >15	May not be required; if required, lower dose 0.05 IU/kg/hr
Potassium replacement	Initial rate 10-20 mmol/hr; often a large deficit	Deficits variable
VTE prophylaxis	Not usually clinically relevant	Major cause of morbidity and mortality
Treat underlying cause	Required	Required