Acute management of glucose disorders

Question 1

What is the most dangerous complication in T1DM?

Answer 1

hypoglycemia - coma

Question 2

What is a combination that could ppt Wernicke’s encephalopathy?

Answer 2

1. prolonged carb administration (from TPN)

2. w/o thiamine supplementation

Question 3

What are 3 cardinal features of DKA in Type 1?

Answer 3

1. Hyperglycemia
2. Ketosis
3. Acidemia

Question 4

What is the presentation of DKA?

Answer 4

1. Abdominal pain (in CHILDREN)
2. Polydipsia
3. Polyuria
4. Blurred vision
5. Kussmaul
6. fruity breath odor

Question 5

What are electrolyte changes in DKA?

Answer 5

1. hypokalemia

2. hyponatremia

Question 6

What is the Tx of DKA?

Answer 6

1. Rapid fluid expansion (IV, isotonic saline)
2. correct Hyperketonia, hyperglycemia
3. prevent hypokalemia

Question 7

What are S/Sx of HyperGlycemic Hyperosmolar state? (HHS)

Answer 7

1. Hyperglycemia
2. Hyperosmolarity
3. Severe dehydration
4. NO KETOACIDOSIS (diff from DKA)

Question 8

Who does HHS usually affect?

Answer 8

Type 2

elderly (not enough fluids, dialysis, burns)

Question 9

What are lab values of HHS?

Answer 9

BG > 600 mg/dL

Serum osmolarity > 320 mOsm/L

Question 10

What is the tx of HHS?

Answer 10

usually ICU admission

1. iv fluids
2. iv insulin
3. potassium

Question 11

What is a special concern in diabetic pediatric groups?

Answer 11

1. Cerebral edema (increase intracranial pressure)
   - -headache, vomiting
2. signs of neuro deterioration
   - -bradycardia, Seizures, Incontinence

Question 12

What should you do with a hypoglycemia pt?

Answer 12

1. ALWAYS check BG
2. give glucose (D10/D50/food), observe
3. in SU induced hypoglycemia - 24 hour observation