diabetes complications Flashcards
mechanism DKA
lack of insulin –> lipolysis –> excess fatty acids –> ketones
what can precipitate a DKA
infection, missed insulin, MI
symptoms DKA
abdo pain, polyuria, dehdrated, kussmaul breathing, pear drop breath, reduced LOC
diagnosis DKA (british)
glucose >11 or known DM // pH <7.3 // bicarb <15 // ketones >3 or ketonuria // (anion gap >10)
mx DKA
isotonic saline (0.9% NaCl) // insulin 0.1 unit/kg/hr // correct U+E (esp K)
when should dextrose be used in DKA + how is it administered
when glucose <14 // add 10% dextrose to 0.9% NaCl
what insulin regimes should be continued/ stopped in DKA
continue long acting, stop short acting
when should potassium be given in DKA and at what rate
if K between 3.5-5.5 // 40 mmol/L
what invx define DKA resolution
pH >7.3 // blood ketones <0.6 // bicarb >15
when should ketonaemia + acidosis have resolved by in DKA
24 hours // if not –> endocrinologist
when can subcut insulin be restarted following DKA
after resolution
complications DKA (6)
gastric stasis // thromboembolism // arrhythmia // cerebral oedema // ARDS // AKI
what can cause cerebral oedema in DKA
fluid rescuss
who is most likely to get cerebral oedema in DKA
young people
symptoms cerebral oedema DKA
headache, irritible, vision, focal neuro
who gets HHs
elderly T2DM
mechanism HHS
hyperglycaemia –> raised serum osmolality –> osmotic diuresis –> dehydration + electrolyte imbalance
RF HHS
illness // dementia // sedative drugs
onste of HHS vs DKA
DKA sudden, HHS slower over days
symptoms HHS
dehydrated // polyuria + dipsia // tired // N+V // reduced LOC // focal neuro // hyperviscous –> MI, stroke
diagnosis HHS
hypovolaemia // marked hyperglycaemia (>30) // raised serum osmolarity (>320) // NO ketones or acidosis
mx HHS
0.9% NaCl over 0.5-1L/hr // VTE prophylaxis
when should insulin be given HHS
ONLY if blood glucose STOPS falling when giving fluids
complications HHS
MI or stroke (from hyperviscocity)
