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Endocrine Module > Acute Hyperglycemic Control > Flashcards

Acute Hyperglycemic Control Flashcards

1
Q

What is the most common cause of DKA/HHS?

A

Infection

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2
Q

What are the 3 reasons why hyperglycemia develops?

A

Increased gluconeogenesis, accelerated glycogenolysis, and impaired glucose utilization

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3
Q

Increased released for free FA and hepatic FA oxidation leads to what?

A

Increased ketone production = ketoacidosis = DKA

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4
Q

What is the main metabolic product of ketones?

A

Beta Hydroxybutyrate

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5
Q

What are the 3 components of ketones?

A

Beta hydroxybutytrate, acetoacetate, and acetone

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6
Q

What are the clinical similarities between DKA and HHS?

A

Hyperglycemia, polyuria, polydipsia, polyphasic, weight loss, N/V, dehydration, poor skin turgor, weakness, mental status changes, tachycardia, and hypotension

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7
Q

What are the clinical presentations specific to DKA?

A

Rapid onset, high ketones, kussmaul respirations, fruity breath odor, and abdominal pain

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8
Q

What are the clinical presentations that are specific to HHS?

A

Onset over several days to weeks, mild or no ketones, seizures

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9
Q

What is the minimum glucose cutoff for DKA?

A

250

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10
Q

What is the arterial pH range for MILD DKA?

A

7.25-7.30

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11
Q

What is the arterial pH range for MODERATE DKA?

A

7.0-7.24

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12
Q

What is the arterial pH range for SEVERE DKA?

A

<7

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13
Q

What is the serum bicarb range for MILD DKA?

A

15-18

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14
Q

What is the serum bicarb range for MODERATE DKA?

A

10-14

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15
Q

What is the serum bicarb range for SEVERE DKA?

A

<10

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16
Q

What is positive in DKA across all stages?

A

Urine and Serum Ketones

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17
Q

What is the anion gap for MILD DKA?

A

> 10

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18
Q

What is the anion gap for MODERATE DKA?

A

> 12

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19
Q

What is the anion gap for SEVERE DKA?

A

> 12

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20
Q

What is the glucose value for HHS?

A

600

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21
Q

What is the arterial pH for HHS?

A

> 7.3

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22
Q

What is the serum bicarb in HHS?

A

> 15

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23
Q

Are ketones found in HHS?

A

NO

24
Q

What is the serum osmolality in HHS?

A

> 320, dehydrated

25
Q

What must you do with sodium prior to proceeding with treatment therapy options?

A

Correct it

26
Q

How do you correct sodium?

A

Blood Glucose - 100 = A
A/100 = B
B x 1.6 = C
C + Current Sodium = Corrected Sodium

27
Q

Is sodium usually high or low in DKA vs HHS?

A

DKA: LOW
HHA: HIGH

28
Q

What is the LOW potassium range?

A

<3.3

29
Q

What is the HIGH potassium range?

A

> 5.2

30
Q

When is osmolality low?

A

High amount of water in relation to dissolved particles and you have over hydration

31
Q

When is osmolality high?

A

Deficient fluid volume and dehydration

32
Q

Do you use corrected sodium in the osmolality equation?

A

NO

33
Q

What does a larger anion gap mean?

A

Severe acidosis

34
Q

Do you use corrected sodium in anion gap equation?

A

NO

35
Q

What is the Sodium IV Fluid Algorithm for DKA?

A
  1. Normal Saline Immediately
  2. Correct Sodium
  3. Low Sodium = Keep normal saline
  4. Normal/High Sodium = stop normal, start half saline
  5. Once glucose is 200, change to D5W/half saline
36
Q

What is the Potassium IV Fluid Algorithm for DKA?

A
  1. Low <3.3 = give potassium, HOLD insulin
  2. Normal 3.3-5.2 = give potassium and insulin
  3. High >5.2 = stop potassium, GIVE insulin
37
Q

What is the Insulin Algorithm for DKA?

A
  1. Start Insulin 0.14 units/kg/hr (ONLY IF POTASSIUM IS OK)
  2. If it does not fall 10% continue regimen
  3. Glucose = 200
  4. Change rate to 0.02-0.05 units/kg/hr
  5. OR give 0.1 units/kg SQ every 2hrs
38
Q

What do you do with Insulin upon DKA resolution?

A
  1. Keep glucose 150-200 until DKA resolves
  2. Keep IV insulin for 1-2 hrs after starting SQ therapy
  3. Restart SQ therapy at patient doses prior to DKA or at 0.5-0.8 units/kg/day
  4. Wait until anion gap closes to turn off insulin
39
Q

When should you treat serum bicarb?

A

<6.9

40
Q

When should you treat serum phosphate?

A

<1

41
Q

What is the definition of resolution of DKA?

A

Blood glucose < 200 AND (2 0f 3)
1. Bicarb >15
2. pH >7.3
3. Calculated Anion Gap <12

42
Q

What is the Sodium IV Fluid Algorithm for HHS?

A
  1. Normal Saline Immediately
  2. Correct Sodium
  3. Low Sodium = Keep normal saline
  4. Normal/High Sodium = stop normal, start half saline
  5. Once glucose is 300, change to D5W/half saline
43
Q

What is the Potassium IV Fluid Algorithm for HHS?

A
  1. Low <3.3 = give potassium, HOLD insulin
  2. Normal 3.3-5.2 = give potassium and insulin
  3. High >5.2 = stop potassium, GIVE insulin
44
Q

What is the Insulin Algorithm for HHS?

A
  1. Start Insulin 0.14 units/kg/hr (ONLY IF POTASSIUM IS OK)
  2. If it does not fall 10% continue regimen
  3. Glucose = 300
  4. Change rate to 0.02-0.05 units/kg/hr
  5. OR give 0.1 units/kg SQ every 2hrs
45
Q

What do you do with Insulin upon HHS resolution?

A
  1. Keep glucose 200-300 until DKA resolves
  2. Keep IV insulin for 1-2 hrs after starting SQ therapy
  3. Restart SQ therapy at patient doses prior to DKA or at 0.5-0.8 units/kg/day
46
Q

What is the definition of resolution of HHS?

A

Blood Glucose <300 AND
1. Normal Osmolality <315
2. Normal mental status

47
Q

What are the 4 acute complications?

A

Hypoglycemia, Hypokalemia, Hyperglycemia, and Cerebral Edema

48
Q

What causes hypoglycemia?

A

Agressive insulin

49
Q

What causes Hypokalemia?

A

Aggressive insulin

50
Q

What causes Hyperglycemia?

A

Insulin stopped too early

51
Q

What causes Cerebral Edema?

A

Plasma osmolality decreases too quickly

52
Q

When should you routinely monitor ketones?

A

BG = >300

53
Q

What does Ketostix measure?

A

Acetoacetate

54
Q

What does Blood Ketones measure?

A

Beta-Hydroxybutyrate

55
Q

When should you increase the frequency of SMBG and ketone monitoring to every 2 hours?

A

Sick Days

Endocrine Module (16 decks)

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