5: Diabetes emergency and high glucose states Flashcards
Can DKA occur in T1 and T2 diabetes?
Yes
but it’s far more common in Type 1 diabetics
How is DKA diagnosed?
Ketonaemia - blood ketone levels > 3mmol/L
Blood glucose conc. > 11.0mmol/L
Bicarbonate levels < 15mmol/L
pH < 7.3
What name is given to DKA in which blood glucose levels are normal?
Euglycaemic DKA
What commonly triggers DKA?
Infection
Alcohol and drugs
Insulin non-adherence
New diagnosis of diabetes
What are the symptoms of DKA?
Thirst
Polyuria
Flushed
Vomiting
Abdominal pain
Kussmaul’s respiration +/- ketone smell
What infections commonly cause DKA?
Sepsis (systemic)
Gastroenteritis
Although blood glucose > 11.1 mmol/L is diagnostic of DKA, what is the average level found in DKA patients?
40 mmol/L
Which electrolyte is raised in DKA?
Potassium
What complication of insulin treatment can occur in patients with low-normal potassium?
Hypokalaemia
What blood ketone level is diagnostic of DKA?
> 3.0 mmol/L
Which ketones are detected in the
a) blood
b) urine?
a) Blood - beta hydroxybutarate
b) Urine - acetoacetate
People with T1 diabetes are more likely to have other ___ diseases.
autoimmune
High levels of what are lost in DKA?
Fluid
Electrolytes - sodium, potassium, phosphate
What neuro complication of DKA is often fatal?
Cerebral oedema
What is a respiratory complication of DKA?
ARDS
What is an acute complication of DKA which can lead to aspiration?
Gastric dilatation
Where are people with DKA supposed to be placed after admission?
HDU
How is acute DKA managed?
Fluid replacement
Glucose, insulin, potassium
What should be monitored regularly in diabetes patients apart from glucose?
Ketone levels
through blood or urine
What complication of diabetes commonly occurs in the older population and is characterised by hyperglycaemia, hypovolaemia and hyperosmolality?
Hyperglycaemic hyperosmolar syndrome
Which drugs are strongly linked to HHS?
Steroids
What is a rough method of calculating osmolality?
Serum osmolality = 2[Na+ + K+]+Glucose+Urea
What is lactic acid a byproduct of?
Anaerobic respiration i.e anaerobic metabolism of glucose
What is the normal range of lactate concentrations?
0.6 - 1.2 mmol/L
What can lactate concentration reach during intense exercise?
10 mmol/L
Are hyperlactataemia and lactic acidosis the same thing?
No, patient can have hyperlactataemia without being in lactic acidosis
Lactic acidosis is more likely when a patient’s lactate concentration is > _ mmol/L.
> 5 mmol/L
Type A lactic acidosis is associated with ___ - infarction, cardiogenic and hypovolaemic shock.
Type B lactic acidosis is associated with liver ___, leukaemia and diabetes.
Type A - hypoxia
Type B - liver damage, leukaemia, diabetes
Which drug, used to treat diabetes, is associated with lactic acidosis?
Metformin
What are the symptoms of lactic acidosis?
Hyperventilation
Confusion, stupor
What are the lab findings of lactic acidosis?
Reduced bicarbonate / pH
Raised anion gap
How is lactic acidosis managed?
Fluid replacement
Treatment of underlying condition
Withdrawal of drugs which may be causing it (e.g metformin)
Apart from DKA, HHS and lactic acidosis, what is another type of acidosis?
Alcohol-induced acidosis
