5: Diabetes emergency and high glucose states

Question 1

Can DKA occur in T1 and T2 diabetes?

Answer 1

Yes

but it’s far more common in Type 1 diabetics

Question 2

How is DKA diagnosed?

Answer 2

Ketonaemia - blood ketone levels > 3mmol/L

Blood glucose conc. > 11.0mmol/L

Bicarbonate levels < 15mmol/L

pH < 7.3

Question 3

What name is given to DKA in which blood glucose levels are normal?

Answer 3

Euglycaemic DKA

Question 4

What commonly triggers DKA?

Answer 4

Infection

Alcohol and drugs

Insulin non-adherence

New diagnosis of diabetes

Question 5

What are the symptoms of DKA?

Answer 5

Thirst

Polyuria

Flushed

Vomiting

Abdominal pain

Kussmaul’s respiration +/- ketone smell

Question 6

What infections commonly cause DKA?

Answer 6

Sepsis (systemic)

Gastroenteritis

Question 7

Although blood glucose > 11.1 mmol/L is diagnostic of DKA, what is the average level found in DKA patients?

Answer 7

40 mmol/L

Question 8

Which electrolyte is raised in DKA?

Answer 8

Potassium

Question 9

What complication of insulin treatment can occur in patients with low-normal potassium?

Answer 9

Hypokalaemia

Question 10

What blood ketone level is diagnostic of DKA?

Answer 10

> 3.0 mmol/L

Question 11

Which ketones are detected in the

a) blood
b) urine?

Answer 11

a) Blood - beta hydroxybutarate

b) Urine - acetoacetate

Question 12

People with T1 diabetes are more likely to have other ___ diseases.

Answer 12

autoimmune

Question 13

High levels of what are lost in DKA?

Answer 13

Fluid

Electrolytes - sodium, potassium, phosphate

Question 14

What neuro complication of DKA is often fatal?

Answer 14

Cerebral oedema

Question 15

What is a respiratory complication of DKA?

Answer 15

ARDS

Question 16

What is an acute complication of DKA which can lead to aspiration?

Answer 16

Gastric dilatation

Question 17

Where are people with DKA supposed to be placed after admission?

Answer 17

HDU

Question 18

How is acute DKA managed?

Answer 18

Fluid replacement

Glucose, insulin, potassium

Question 19

What should be monitored regularly in diabetes patients apart from glucose?

Answer 19

Ketone levels

through blood or urine

Question 20

What complication of diabetes commonly occurs in the older population and is characterised by hyperglycaemia, hypovolaemia and hyperosmolality?

Answer 20

Hyperglycaemic hyperosmolar syndrome

Question 21

Which drugs are strongly linked to HHS?

Answer 21

Steroids

Question 22

What is a rough method of calculating osmolality?

Answer 22

Serum osmolality = 2[Na⁺ + K⁺]+Glucose+Urea

Question 23

What is lactic acid a byproduct of?

Answer 23

Anaerobic respiration i.e anaerobic metabolism of glucose

Question 24

What is the normal range of lactate concentrations?

Answer 24

0.6 - 1.2 mmol/L

Question 25

What can lactate concentration reach during intense exercise?

Answer 25

10 mmol/L

Question 26

Are hyperlactataemia and lactic acidosis the same thing?

Answer 26

No, patient can have hyperlactataemia without being in lactic acidosis

Question 27

Lactic acidosis is more likely when a patient’s lactate concentration is > _ mmol/L.

Answer 27

> 5 mmol/L

Question 28

Type A lactic acidosis is associated with ___ - infarction, cardiogenic and hypovolaemic shock.

Type B lactic acidosis is associated with liver ___, leukaemia and diabetes.

Answer 28

Type A - hypoxia

Type B - liver damage, leukaemia, diabetes

Question 29

Which drug, used to treat diabetes, is associated with lactic acidosis?

Answer 29

Metformin

Question 30

What are the symptoms of lactic acidosis?

Answer 30

Hyperventilation

Confusion, stupor

Question 31

What are the lab findings of lactic acidosis?

Answer 31

Reduced bicarbonate / pH

Raised anion gap

Question 32

How is lactic acidosis managed?

Answer 32

Fluid replacement

Treatment of underlying condition

Withdrawal of drugs which may be causing it (e.g metformin)

Question 33

Apart from DKA, HHS and lactic acidosis, what is another type of acidosis?

Answer 33

Alcohol-induced acidosis