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Why Is Sodium High In Dka?

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Diabetic Ketoacidosis

Initial Evaluation Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors (Table 14–18). The most common precipitating factor is infection, followed by noncompliance with insulin therapy.3 While insulin pump therapy has been implicated as a risk factor for DKA in the past, most recent studies show that with proper education and practice using the pump, the frequency of DKA is the same for patients on pump and injection therapy.19 Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis4 Inadequate insulin treatment or noncompliance4 New-onset diabetes4 Cardiovascular disease, particularly myocardial infarction5 Acanthosis nigricans6 Acromegaly7 Arterial thrombosis, including mesenteric and iliac5 Cerebrovascular accident5 Hemochromatosis8 Hyperthyroidism9 Pancreatitis10 Pregnancy11 Atypical antipsychotic agents12 Corticosteroids13 FK50614 Glucagon15 Interferon16 Sympathomimetic agents including albuterol (Ventolin), dopamine (Intropin), dobutamine (Dobutrex), terbutaline (Bricanyl),17 and ritodrine (Yutopar)18 DIFFERENTIAL DI Continue reading >>

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Popular Questions

  1. Boatswain2PA

    Patient today - 21 yo type 1 diabetic train-wreck (GCS of 4). Na was 124 and I'm trying to figure out why.
    Here's what I remember.
    BP 50/38, P180, R30+
    BS 1390 (after 20 units Insulin)
    K 9.2
    ABGs were horrible, only thing I remember was pH of 6.72
    Urine was clean, but sweet (1000 glucose) .
    Don't remember specifics of other lab values, but they all made sense and could be chalked up to sepsis/DKA.
    I just can't figure out why the Na was 124. I read that Sodium drops by 1 per 62 glucose up to 400, and 1:24 for glucose over 400, but I don't understand why. Pt was incredibly dry so beans would use sodium reuptake to conserve water. Plus through hemoconcentration I would expect a higher sodium concentration.
    So I can't understand why the sodium was at 124. Can anyone help out?

  2. Paseo Del Norte

    Boatswain2PA said: ↑
    Patient today - 21 yo type 1 diabetic train-wreck (GCS of 4). Na was 124 and I'm trying to figure out why.
    Here's what I remember.
    BP 50/38, P180, R30+
    BS 1390 (after 20 units Insulin)
    K 9.2
    ABGs were horrible, only thing I remember was pH of 6.72
    Urine was clean, but sweet (1000 glucose) .
    Don't remember specifics of other lab values, but they all made sense and could be chalked up to sepsis/DKA.
    I just can't figure out why the Na was 124. I read that Sodium drops by 1 per 62 glucose up to 400, and 1:24 for glucose over 400, but I don't understand why. Pt was incredibly dry so beans would use sodium reuptake to conserve water. Plus through hemoconcentration I would expect a higher sodium concentration.
    So I can't understand why the sodium was at 124. Can anyone help out?
    Click to expand... Glucose is osmotically active and causes an intracellular to extracellular shift of water. This acts to effectively "dilute" the Sodium. However, you should run your Sodium through a correction formula in any event. If the corrected Sodium is low, you need to consider other issues such as elevated lipids.

  3. chimichanga

    Wow...I used to love ER, for that very type of pt.
    Now all I can ask is, why the he!! didn't someone bring him in a couple days earlier??
    That kind of pt is EXACTLY the reason why I left the damn ER for good.
    That poor guy was just festering (dying) at home
    FUBAR

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