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Dka Hypernatremia

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Hypernatraemia And Acidosis

aka Metabolic Muddle 005 A 20 year old male presents with 3 days of lethargy and generalised malaise. He is confused and looks very unwell. The following blood tests are obtained: Questions Q1. Describe the acid base disturbance. Q2. What is the likely diagnosis? Q3. Describe the electrolyte abnormalities. Q4.Should the corrected sodium be used for calculating the anion gap? Q5. It emerges that the patient has recently been diagnosis with Schizophrenia and has commenced olanzepine. What is the significance of this additional history? Q6. An amylase is measured and is found to be 3 times the upper limit of normal. What is the significance of this finding? References and Links Beck, LH. Should the actual or the corrected serum sodium be used to calculate the anion gap in diabetic ketoacidosis? CLEVELAND CLINIC JOURNAL OF MEDICINE 2001; 68 (8) 673-674. (pdf) Continue reading >>

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Popular Questions

  1. launchpad

    can anyone plz tell me what happens to the Na and K levels in DKA.kaplan says there is hypernatremia and hypokalemia.

  2. frontal

    There is no hypernatremia in DKA. There is electrolyte loss in DKA primariy due to hyperglycemia causing osmotic diuresis, so the patient is depleted of both Na and K, but the serum levels of potassium maybe normal or even elevated. This is because of a disproportionate loss of water (osmotic diuresis) and because of acidosis, which forces the hydrogen ions into cells in exchange for K ions. Remember: a patient with DKA is potassium depleted, even if serum potassium values are on the higher side at presentation. Renal loss continues and as treatment with insulin is started, a fall in serum potassium is likely to be observed because insulin pushes the K ions back into the cells. Electrolye monitoring is necessary while treating the patient, so that insulin dose can be adjusted and fluids given appropriately.

  3. frontal

    A normal serum sodium level in DKA would indicate profound dehydration.

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