21 - diabetic emergencies Flashcards
what is triad of DKA
- hyperglycemia
- ketosis
- acidosis
what type of DM is DKA primarily in
1
2 main patho concepts in DKA
- relative insulin def.
- counter regulatory hormone excess due to failure of normal mechanisms
- glucagon, catecholamine, cortisol, GH
10 causes of DKA
- lack of insulin
- infection
- MI
- PE
- stroke
- pnacreatitis
- substance abuse
- meds
- trauma
- surg.
DKA signs and Sx
DKA
Diuresis, delirium/dizzy, dehydration
Kussmaul breathing, keto breath
Abdo pain
3 main goals of DKA Tx
- restore volume
- correct lyte imbalance
- replensh insulin
what is fluid replacement
give half amount lost in first 8 hours
- 1-2L NS in first hour
- once glucose falls below 16, change to D5W
when to start giving insulin
once K levels reach >3.3 and BP restored
how to dose Kcl
based on the levels of K found in the serum
role for bicarb in therapy
not one unless pH is
big 3 of DKA Tx
- fluid resus
- glucose control with insulin
- correct K
what is dreaded outcome in DKA
cerebral edema
what defines hyperosmolar hyperglycemic state (HHS)
glucose >33
ph>7.3
bicarb>15
AG320
what is key feature to diff DKA and HHS
ketones
how are DKA and HHS diff. in presentation
HHS over days to weeks
Tx for HHS
same as DKA but no role for bicarb
what is whipple’s triad in hypoglycemia
- low plasma glucose
- Sx suggestive of hypoglycemia
- prompt resolution when given glucose
main causes of hypoglycemia
#1 excessive insulin - alc., sepsis, liver disease
2 classes of Sx in hypo
- autonomin
- diaphoresis, nausea, hunger, tachy - neuroglycopenic
- HA, confusion, seiure, coma
Tx of hypo
prehost- glucose fods
in ER - D50 IV
