Diabetic Ketoacidosis

(DKA)
Preceptor :
Deddy Satriya Putra, S.Ked,.dr.,Sp.A
(K).
Presented by:
Rahmi Diffilianti

Introduction
Diabetic

ketoacidosis is a major
cause of morbidity and mortality in
children with type 1 diabetes
mellitus

Mortality

is mainly associated with

cerebral edema that occurs around
57 % - 87 % of all deaths from KAD

 DKA

prevalence in the United States

is estimated at 4.6 - 8 per 1,000
diabetics with mortality of about 2-5
%.
in Indonesia incidence of deaths
from 0.15 - 0.3 %

Definition
results from absolute or relative
deficiency of circulating insulin and
the combined effects of increased
levels of the counterregulatory
hormones: catecholamines,
glucagon, cortisol and growth
hormone

Frequency of DKA
There

is wide geographic variation in

the frequency of DKA at onset of
diabetes; rates inversely correlate
with the regional incidence of T1DM.
Frequencies range from
approximately 15% to 70% in Europe
and North America (A) (2327). DKA
at diagnosis is more common in
younger children

Clinical manifestations
Dehydration
Rapid, deep, sighing (Kussmaul
respiration)
Nausea, vomiting, and abdominal
pain mimicking an acute abdomen
Progressive obtundation and loss of
consciousness
Increased leukocyte count with left
shift
Non-specific elevation of serum

Trias of DKA

Goals of therapy
Correct dehydration
Correct acidosis and reverse ketosis
Restore blood glucose to near
normal
Avoid complications of therapy
Identify and treat any precipitating
event

Physical
Examinatio
n

History

chest
radiogra
ph &
Blood
Tests

Diagnosis

Identity
AF, boy, 14 years 8 months old, came to hospital at
March 13rd , 2015
Alloanamnesis
Parents of Patients
Chief complaint
Loss of consciousness since 1 days before came to
hospital

CASE ILLUSTRATION

Present illness history

Since 3 days SMRs patients vomiting vomiting . Vomiting every time fed and
watered . Patients complain of difficulty in
swallowing and sore on tongue . Appears
patches - reddish white patches on the tongue
and around the sky - the sky . Abdominal pain (
+ ) , headache ( + ) . Patients also appears
frequently drinking and frequent urination .
Patients also often wake up at night to urinate .
Urinary volume 1gelas bottled water ( 200
cc ) each time urination . Drastic weight loss ,
but the parents do not know the patient's
weight before. Appetite patients as usual ,
Chapter soft but not diarrhea , fever ( - ) .

months SMRs , patients often

consume sugary drinks , such as tea
and coffee . Patients often make
their own tea and coffee , so that
elderly patients do not know the
amount of sugar used and how many
cups are consumed in a day , but is
expected to > 3 cups of tea ( 900
cc ) in a day . History of taking drugs
(-)

Since 1 week before admitted to hospital

patient that got cough that has been
happened frequently since a month ago, at
the beginning is non-productive cough,then
starting to be productive cough for the
following week with cream colour sputum. No
one around with cough complaint.

Present illness
history

Past illness
history
Asthma (-)
there is no
inpatient
history on
hospital
within 48
hours ago

History

Family illness
history
(-)

Immunizatio
n history
BCG (+)
DPT (+)

General
appearance:
Moderate
illness

Vital sign:
BP : 110/70
Pulse : 120x/minute,
reguler, strong, adequate
RR : 60x/minute
T : 37,9C

Physical examination

Consciousness:
Composmentis

Nutritional status: 97%

height : 94cm
weight : 15 kg
upper arm
circumference : 13 cm
Head circumference: 42

Skin : Pale (+), jaundice

(-), cyanosis (-), ptekie (-)

Head : Normopcephal

Eyes :
Hair : Black, not easily
removed

Physical examination

Normal
Conjunctival anemia (+/+)
Sklera ikteric (-/-)
Pupil isokor 2mm/2mm,
Light reflex: direct (+ / +), indirect (+ /
+)

Ears :

Nose:

Congenital disease
(-)
External canal: secretions
(-), inflammatory signs (-)

Nasal flaring (+)

Mouth:

Neck:

Mucous membranes moist

Intact palate
The tongue is not dirty

Physical examination

Lymphadenopathy (-)
Stiff neck (-)

Thorax
Inspection:
subcostal
retraction (+)
Palpation:
normal
Percussion:
normal
Auscultation
: Ronkhi (+ /
+) in both of
lungs

Abdomen
Normal

Physical examination

Extremity
Normal

Neurological
Status
Normal

Work Diagnosis:
Suspek diabeticum ketoacidosis +
hipokalemia

Nutrition Diagnosis:
severe nutrition

Suggest examination :
C

peptide
AGDA
Hba1c

 IVFD

NaCl 0,9% + 20meq

KCl 26 tpm makro
Insulin drip 2 unit/hour
Ceftriaxon 2x1 gr
GDS /hour

Therapy

Prognosis
Quo

ad vitam

: Bonam

Quo

ad functionam : Malam

Thank You