Acute conditions

Question 1

What is the triad of symptoms for someone with DKA?

Answer 1

1. Hyperglycaemia
2. Acidaemia
3. Ketonaemia

Question 2

What is DKA?

Answer 2

Glucose can’t be taken up into cells due to lack of insulin so ketoacidosis takes place (starvation mechanism). Ketoacidosis produces acteone which is acidic so patient becomes hyperglycaemic and acidotic

Question 3

What is the typical presentation of DKA? (7)

Answer 3

1. Gradual drowziness
2. N+V
3. Abd. pain
4. Kussmaul breathing (rapid+deep)
5. Acetone breath
6. Dehydration
7. Hyperglycaemia symptoms

Question 4

What are the triggers for DKA? (3)

Answer 4

1. Stress
2. Infection
3. Insufficient insulin

Question 5

Why do DKA patients become dehydrated?

Answer 5

Reduced insulin = hyperglycaemia = fluid loss = dehydration

Question 6

How would you confirm DKA? (3)

Answer 6

ABG + blood tests:

1. Acidaemia (venous pH <7.3 or HCO3- <15)
2. Hyperglycaemia (>11mmol/L)
3. Ketonaemia (>3) / Ketonuria

Question 7

How do you manage DKA? (4)

Answer 7

1. Rehydrate (1L saline over an hour)
2. Replace insulin + dextrose (IV) - prevent subsequent hypo (0.1 unit/kg/hr)
3. Monitor K+ (prevent arrhythmia)
4. Treat underlying cause

Question 8

What is hyperosmolar hyperglycaemic syndrome (HHS)?

Answer 8

Complication of uncontrolled DM characterised by:

1. Profound hyperglycaemia (>33mmol/L)
2. Vol depletion (hyperosmolality)
3. Absence of ketoacidosis

Question 9

What is the presentation of HHS?

Answer 9

Symptoms occur over days/week

1. Polydipsia
2. Polyuria
3. Weight loss
4. Alterations in mental state

Question 10

Why is HHS more common in T2DM compared to DKA?

Answer 10

Insulin levels in T2DM are high which is thought to suppress ketogenesis unlike DKA where the liver thinks there’s no insulin so makes ketones.

Question 11

What Ix are done to confirm HHS? (4)

Answer 11

1. Blood glucose (>33.3mmol/L)
2. Blood Urea (increased vol depletion)
3. Hypernaturemia (water pulled out of cells - can cause coma)
4. Serum osmolarity

Question 12

How is HHS managed?

Answer 12

1. Rehydration
2. K+ replacement
3. Treat underlying cause
4. Only give IV insulin if glucose doesn’t fall >5mmol/L/hr with fluids

Question 13

What are the three commonest causes of hypoglycaemia in diabetics?

Answer 13

1. Insulin overdose
2. Sulphonylurea (gliclazide) overdose
3. Not eating

Question 14

What are the causes of hypoglycaemia in non-diabetics? (5)

Answer 14

PLAIN:

1. Pituitary insufficiency
2. Liver failure
3. Addison’s
4. Islet cell tumours
5. Non-pancreatic neoplasms

Question 15

How would you investigate a hypoglycaemic event? (4)

Answer 15

1. Serum glucose (<3.3mmol/L)
2. LFTs (check for liver failure)
3. Serum insulin
4. Serum cortisol (Addison’s)

Question 16

How would you manage a hypoglycaemic event in a T2 diabetic with a sulphonylurea OD? (3)

Answer 16

1. Oral glucose
2. Glucagon IM
3. IV dextrose

Question 17

What defines hyponatraemia?

Answer 17

Serum Na+ <135mmol/L

Question 18

What is a potential complication of fluid resus with DKA in young people?

Answer 18

Cerebral oedema