Diabetes emergencies

Question 1

what is diabetic ketoacidosis?

Answer 1

a disordered metabolic state that usually occurs in the context of an absolute or relative insulin deficiency accompanied by an increase in counter regulatory hormones

Question 2

name some things which can contribute to DKA?

Answer 2

infection
illicit drug use
alcohol
non adherence with treatment
newly diagnosed diabetes

Question 3

what are the typical signs and symptoms of DKA?

Answer 3

thirst
polyuria
dehydration

Question 4

name some ketone related signs and symptoms of DKA

Answer 4

abdo pain
nausea
vomiting
breathless- Kaussmaul's breathing
flushed

Question 5

at presentation is sodium high or low? (DKA)

Answer 5

low

Question 6

at presentation is creatinine high or low?(DKA)

Answer 6

high

Question 7

at presentation is lactate high or low(DKA)

Answer 7

usually high

Question 8

how do you manage and treat DKA?

Answer 8

IV fluids
insulin
potassium (rarely)
bicarbonate (only in severe cases)

Question 9

what are the typical features of hyperglycaemic hyperosmolar syndrome (HHS)?

Answer 9

diabetes may be known
usually older patients
high refined CHO intake pre event
risk associations- stroke/MI, sepsis, glucocorticoids, thiazides

Question 10

is sodium high or low on admission of HHS?

Answer 10

high

Question 11

what usually has higher glucose levels-DKA or HHS?

Answer 11

HHS

Question 12

what is normal lactate range?

Answer 12

0.6-1.2mmol/L

Question 13

what is the normal range of ion gap?

Answer 13

10-18 mmol/L

Question 14

what is type A lactic acidosis associated with?

Answer 14

tissue hypoxaemia. e,g infarcted tissue in bowel ischaemia

Question 15

what is type B lactic acidosis associated with?

Answer 15

liver disease
leukaemic disease
diabetes

Question 16

what might this be?
hyperventilation
mental confusion
stupor or coma if severe
reduced bicarb
raised ion gap
raised phosphate

Answer 16

lactic acidosis

Question 17

how do you treat lactic acidosis?

Answer 17

fluids

antibiotics