Adult Hyperglycaemia

Question 1

Differentials for Hyperglycaemia

Answer 1

• Intoxication
• Opioid toxicity
• Envenomation
• Stroke

Question 2

Focused assessment for Hyperglyceamia

Answer 2

• AEIOUTIPS
• MASS
• Qsofa

Question 3

What is the QSOFA assessment

Answer 3

2 or more points > risk of sepsis
Altered GCS - 1 point
Respiratory rate > 22 - 1 point
SBP < 100 - 1 point

Question 4

Hyperglycaemia clinical risks of deterioration

Answer 4

• Seizures
• LOC
• Respiratory distress
• Renal damage
• Arrythmias (electrolyte imbalance)
• Sepsis
• Shock

Question 5

Care objectives for hyperglycaemia

Answer 5

• Identification of high-risk hyperglycaemia
• hydration where indicated.

Question 6

Factors associated with increased risk of hyperglcaemic emergencies

Answer 6

• Children and young people with Known type 1 diabetes
• Unstable

Question 7

What is the threshold for symptomatic hyperglycaemia / ketosis?

Answer 7

BGL ≥ 11 OR ketones ≥ 0.6 mmol/L

Symptomatic hyperglycaemia may indicate underlying diabetes or other health issues.

Question 8

What is a key characteristic of diabetic patients taking SGLT2 inhibitors?

Answer 8

They may present with raised ketones but normal BGL

SGLT2 inhibitors can influence ketone levels independently of blood glucose levels.

Question 9

What constitutes mild to moderate hyperglycaemia / ketosis?

Answer 9

BGL 11 - 27.8 AND / OR ketones 0.6 - 3 mmol/L

Patients may show mild diabetes-related illness symptoms.

Question 10

What are some clinical signs of mild diabetes-related illness?

Answer 10

• Mild lethargy
• Dry mouth / thirst
• Polydipsia
• Polyuria

These symptoms can indicate a mild state of hyperglycaemia.

Question 11

What should be excluded when diagnosing mild to moderate hyperglycaemia?

Answer 11

• Acute coronary syndrome
• Infection / sepsis

These conditions may require emergency department care.

Question 12

What defines severe hyperglycaemia / ketosis?

Answer 12

Any of:
* BGL > 27.8
* Ketones > 3 mmol/L
* Less than adequate perfusion
* Clinical features of DKA
* Clinical features of HHS

DKA stands for Diabetic Ketoacidosis and HHS stands for Hyperglycemic Hyperosmolar State.

Question 13

What are clinical features of DKA?

Answer 13

• Altered conscious state
• Kussmaul breathing / tachypnoea
• Ketotic breath
• Dehydration
• Profound thirst
• Nausea / vomiting
• Abdominal pain

DKA is a serious condition requiring immediate medical attention.

Question 14

What are clinical features of HHS?

Answer 14

• Altered conscious state
• Dehydration

HHS can be life-threatening and needs urgent care.

Question 15

What is the initial IV fluid treatment for adults with severe hyperglycaemia?

Answer 15

Normal Saline 1000 - 2000 mL IV

Administer over 1 hour if BP > 90 mmHg.

Question 16

What should be done if there is an inadequate response to IV fluid in adults?

Answer 16

Escalate to MICA for Consideration of vasopressors as per CPG A0705 Shock

Inadequate fluid response may indicate shock or severe dehydration.

Question 17

What is the initial IV fluid treatment for paediatric patients?

Answer 17

Normal Saline 10 mL / kg IV titrated to perfusion status

Pediatric dosing must be carefully monitored for effectiveness.

Question 18

What is the risk of fluid overload?

Answer 18

History of cardiac failure
Chronic renal failure
Elderly

All other patients include chronic renal failure and elderly.

Question 19

What is the administration guideline for normal saline if BP > 90mmHg?

Answer 19

Administer over 1 hour.

Question 20

What is the administration guideline for normal saline if BP ≤ 90mmHg?

Answer 20

Administer as bolus.

Question 21

What are the care objectives for administering normal saline?

Answer 21

Identification of high-risk hyperglycaemia and hydration where indicated.

Question 22

What are factors associated with increased risk of hyperglycaemic emergencies?

Answer 22

Children and young people with known type 1 diabetes, unstable glycaemic control, diabetes medication omission (especially insulin), use of an insulin pump, past DKA, acute infection and sepsis, pancreatitis, myocardial infarction/unstable angina, trauma, surgery or burns, medications (corticosteroids, atypical antipsychotics, immunosuppressive agents, SGLT2i), alcohol and recreational drugs, elderly people.

Question 23

Why can the use of an insulin pump lead to hyperglycaemia and DKA?

Answer 23

As only rapid-acting insulin is administered by pumps (no long-acting insulin is used), any interruption to use of the pump can rapidly lead to hyperglycaemia and DKA.

Question 24

What are the specific medications that can increase the risk of hyperglycaemic emergencies?

Answer 24

Corticosteroids, atypical antipsychotics, immunosuppressive agents, SGLT2i.

Question 25

What are the considerations for elderly people regarding DKA?

Answer 25

Signs of DKA may be subtle, mortality rates may be higher, and type 1 diabetes can present at any age.