SAQ 800 – Endocrinology – diabetic ketoacidosis acid-base management

Marked out of 18.00

A 20-year-old woman is brought to ED with one week of vomiting and confusion. You suspect diabetic ketoacidosis.

List three (3) other possible causes for raised ketones.

(Marked out of 3.0)

Observation Value
pH 7.16
pCO2 33 mmHg
pO2 40 mmHg
HCO3- 12 mmol/L
BE -15.7 mmol/L
Hb 137 g/L
Na+ 130 mmol/L
Cl- 90 mmol/L
K+ 5.2 mmol/L
Glucose 37.0 mmol/L
Lactate 2.2 mmol/L
Ketones 3.0 mmol/L


/ 3

List three (3) diagnostic criteria for DKA.

(Marked out of 3.0)


/ 3

Give a formula for strong ion difference.

(Marked out of 1.0)


/ 1

What acid-base derangement is expected from this patient's strong ion difference?

(Marked out of 1.0)


/ 1

Give one formula that could be used for sodium correction.

(Marked out of 1.0)


/ 1

You start an insulin infusion as part of initial management. State the rate and goal of the infusion.

(Marked out of 2.0)


/ 2

After three hours of insulin infusion, IV fluids and IV antibiotics, the repeat VBG is shown. What acid-base derangement is now demonstrated by the strong ion difference?

(Marked out of 1.0)

Observation Value
pH 7.12
pCO2 30 mmHg
pO2 63 mmHg
HCO3- 18 mmol/L
BE -17.7 mmol/L
Hb 114 g/L
Na+ 133 mmol/L
Cl- 103 mmol/L
K+ 4.2 mmol/L
Glucose 25.0 mmol/L
Lactate 1.9 mmol/L
Ketones 1.1 mmol/L


/ 1

List the most likely cause of this acid-base derangement, along with four (4) other possible causes.

(Marked out of 6.0)


/ 6

Total Score: 0 / 18

Percentage: 0%