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The Endocrine System > Diabetes Emergencies > Flashcards

Diabetes Emergencies Flashcards

1
Q

How can diabetic ketoacidosis be defined?

A

A disordered metabolic state

Usually occurs in absolute or relative insulin deficiency as well as an increase in counter-regulatory “stress” hormones (glucagon, adrenaline, cortisol and growth hormone)

Ketoacidosis occurs as a result of lipolysis whilst stress hormones induce hyperglycaemia

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2
Q

How can DKA be biochemically diagnosed?

A
  1. >3mmol/l ketonaemia (>2++ of urine dipstick)
  2. >11.0 blood glucose
  3. <15mmol/l bicarbonate (or venous pH <7.3)
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3
Q

DKA is usually caused by which 4 main factors?

A
  1. Infection
  2. Non-adherence with treatment
  3. Newly diagnosed diabetes
  4. Alcohol and illicit drug use
    5.
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4
Q

What are the key signs and symptoms of DKA?

A
  1. Thirst and polyuria
  2. Dehydration
  3. Flushed
  4. Vomiting
  5. Abdominal pain and weakness
  6. Breathless - Kussmaul’s breathing
  7. Ketones on breath
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5
Q

What are the two main associated conditions with DKA?

A
  1. Underlying sepsis
  2. Gastroenteritis
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6
Q

What is the range of blood glucose levels someone with DKA can present at?

A

10 - 100mmol/l

(usually it is around 40 mmol/l)

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7
Q

Above which level is potassium usually at in DKA presentation?

A

>5.5mmol/l

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8
Q

Why is it a worry if potassium levels are low upon presentation?

A

This can cause CV issues and death

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9
Q

What is the normal range of blood potassum levels?

A

3.5-5mmol/l

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10
Q

Below which blood potassium level is it considered dangerous?

A

<3.5mmol/l is considered hypokalaemia

2.5 - 3.0mmol/l is moderate hypokalaemia

<2.5mmol/l is severe hypokalaemia and is the most severe

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11
Q

How are the following affected in a typical DKA presentation:

a) Creatinine
b) Sodium
c) Lactate

A

a) Raised (poor kidney function)
b) Reduced
c) Raised (contributes mildly to acidosis)

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12
Q

Ketones will be above which level in the blood during DKA?

A

>5mmol/l

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13
Q

Which ketone is measured

a) In the blood
b) In the urine?

A

a) Beta-hydroxybutarate
b) Acetoacetate

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14
Q

In most severe cases of DKA, at which level is bicarbonate?

A

< 10mmol/l

(<15mmol/l is diagnostic)

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15
Q

Amylase is often raised in DKA, what may this indicate?

A

Pancreatitis

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16
Q

WCC in severe DKA is at around 25/nL, what may this infer?

A
  1. Infection
  2. Severity of DKA
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17
Q

What is the normal range of amylase in the blood?

A

Usually < 100 U/L

This varies drastically

Some ethnicities can have normal amylase levels at 180 U/L

Amylase levels around 900 U/L are almost diagnostic of pancreatitis

Less remarkably raised amylase levels are not so severely raised

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18
Q

What are the biggest risks of death for adults with DKA?

A
  1. ARDS
  2. Aspiration pneumonia (due to acute gastric dilatation)
  3. Hypokalaemia
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19
Q

What is the biggest risk in children with DKA?

A

Cerebral oedema

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20
Q

How is DKA treated?

A
  1. Fluid is given (0.9% NaCl)
  2. Insulin
  3. Potassium
  4. LMWH

Very rarely are phosphates and bicarbonate given as these correct themselves, but it is not wrong to correct them

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21
Q

Normal ketone levels are below which value?

A

<0.6 mmol/l

22
Q

What is HHS?

A

Hypergylcaemic hyperosmolar syndrome

23
Q

Which complication has a higher mortality?

DKA or HHS?

A

HHS

24
Q

Which people are particularly at risk of HHS?

A
  1. Older people
  2. Younger people of non-caucasian background
    3.
25
Q

In a typical case of HHS, the patient either _______ know they have diabetes or they __________ _______ _______

A

In a typical case of HHS, the patient either doesn’t know they have diabetes or they control diet only

26
Q

How can HHS be brought on?

A
  1. High refined sugar intake
  2. New diagnosis
  3. Infection
  4. Diuretic or steroid use
27
Q

What are the main associated risks for HHS?

A
  1. Cardiovascular event (stroke or MI)
  2. Sepsis
  3. Medications (glucocorticoids and thiazide diuretics)
28
Q

Blood glucose levels in HHS are generally _________ than in DKA

A

Blood glucose levels in HHS are generally higher than in DKA

29
Q

How is osmolarity calculated?

A

2 x [Na+K] + urea + glucose

30
Q

What is the normal range for osmolarity?

A

285 - 295 mmol/kg

31
Q

Osmolarity levels in HHS acn exceed what?

A

400 mmol/kg

32
Q

How do ketone and aidotic levels compare in HHS to DKA

A

They are both lower

33
Q

Generally there is significant renal impairment with a typical case of HHS

True or false?

A

True

34
Q

HHS involves a _____volaemic state

A

HHS involves a hypovolaemic state

35
Q

DKA is generally associated with type ____ diabetes and HHS is associated with type ____ diabetes

A

DKA is generally associated with type 1 diabetes and HHS is associated with type 2 diabetes

36
Q

How is HHS treated?

A
  1. Fluids (very careful not to overload)
  2. Insulin (more slowly than DKA as patient is more sensitive) - may not be required at all
  3. Sodium (increase very slowly and avoid rapid fluctuations)
  4. LMWH
  5. Oral antihyperglycaemic medication (for T2DM e.g. metformin)
  6. Diet
37
Q

Lactate is removed in which way?

A
  1. Hepatic uptake
  2. Aerobic conversion to pyruvate and then to glucose
38
Q

What is the normal range for lactate in the blood?

A

0.6 - 1.2 mmol/l

39
Q

What is the formula to calculate the anion gap?

A

[Na+ + K+] - [HCO3- + Cl-]

40
Q

What is the normal range for the anion gap?

A

10 - 18 mmol/l

41
Q

What makes up the physiologically difference which causes the normal anion gap?

A

-ve Charged proteins, sulphate, phosphate and some organic acids

42
Q

Type A lactic acidosis is associated with what?

A

Tissue hypoxaemia

43
Q

What may be the causes of type A lactic acidosis?

A
  1. Infarcted tissue (e.g. ischaemic bowel)
  2. Cardiogenic shock
  3. Hypovolaemic shock (sepsis (endotoxic shock), haemorrhage)
44
Q

In which instances may type B lactic acidosis occur?

A
  1. Liver disease
  2. Leukaemic states
  3. Diabetes
  4. Inherited metabolic conditions
45
Q

What are the clinical features of lactic acidosis?

A
  1. Hyperventilation
  2. Mental confusion
  3. Stupor or coma if severe
46
Q

What are the classical lab findings for type B lactic acidosis?

A
  1. Reduced bicarbonate
  2. Raised anion gap
  3. Glucose variable – Often raised
  4. Absence of ketonaemia
  5. Raised phosphate
47
Q

What is the treatment for lactic acidosis?

A
  1. Fluids
  2. Antibiotics
  3. Withdraw causative drugs
  4. Treat underlying cause
48
Q

In lactic acidosis, serum osmolarity is ________

A

In lactic acidosis, serum osmolarity is normal

49
Q

What are blood glucose levels like in alcohol induced ketoacidosis?

A

Normal-high

50
Q

What are the target and accepted blood glucose ranges for diabetic inpatients?

A
  • Target level for glucose for hospital inpatients is 6-10mmol/L
  • 4-12mmol/L is accepted
51
Q

What is foot CPR?

A
  1. Check
  2. Protect
  3. Refer

The Endocrine System (35 decks)

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