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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?

24
Q

Which people are particularly at risk of HHS?

A
  1. Older people
  2. Younger people of non-caucasian background
    3.
25
In a typical case of HHS, the patient either _______ know they have diabetes or they __________ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_
In a typical case of HHS, the patient either **doesn't** know they have diabetes or they **control diet only**
26
How can HHS be brought on?
1. High refined sugar intake 2. New diagnosis 3. Infection 4. Diuretic or steroid use
27
What are the main associated risks for HHS?
1. Cardiovascular event (stroke or MI) 2. Sepsis 3. Medications (glucocorticoids and thiazide diuretics)
28
Blood glucose levels in HHS are generally _________ than in DKA
Blood glucose levels in HHS are generally **higher** than in DKA
29
How is osmolarity calculated?
2 x [Na+K] + urea + glucose
30
What is the normal range for osmolarity?
285 - 295 mmol/kg
31
Osmolarity levels in HHS acn exceed what?
400 mmol/kg
32
How do ketone and aidotic levels compare in HHS to DKA
They are both **lower**
33
Generally there is significant renal impairment with a typical case of HHS True or false?
True
34
HHS involves a \_\_\_\_\_volaemic state
HHS involves a **hypo**volaemic state
35
DKA is generally associated with type ____ diabetes and HHS is associated with type ____ diabetes
DKA is generally associated with type **1** diabetes and HHS is associated with type **2** diabetes
36
How is HHS treated?
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
Lactate is removed in which way?
1. Hepatic uptake 2. Aerobic conversion to pyruvate and then to glucose
38
What is the normal range for lactate in the blood?
0.6 - 1.2 mmol/l
39
What is the formula to calculate the anion gap?
[Na+ + K+] - [HCO3- + Cl-]
40
What is the normal range for the anion gap?
10 - 18 mmol/l
41
What makes up the physiologically difference which causes the normal anion gap?
-ve Charged proteins, sulphate, phosphate and some organic acids
42
Type A lactic acidosis is associated with what?
Tissue hypoxaemia
43
What may be the causes of type A lactic acidosis?
1. Infarcted tissue (e.g. ischaemic bowel) 2. Cardiogenic shock 3. Hypovolaemic shock (sepsis (endotoxic shock), haemorrhage)
44
In which instances may type B lactic acidosis occur?
1. Liver disease 2. Leukaemic states 3. Diabetes 4. Inherited metabolic conditions
45
What are the clinical features of lactic acidosis?
1. Hyperventilation 2. Mental confusion 3. Stupor or coma if severe
46
What are the classical lab findings for type B lactic acidosis?
1. Reduced bicarbonate 2. Raised anion gap 3. Glucose variable – Often raised 4. Absence of ketonaemia 5. Raised phosphate
47
What is the treatment for lactic acidosis?
1. Fluids 2. Antibiotics 3. Withdraw causative drugs 4. Treat underlying cause
48
In lactic acidosis, serum osmolarity is \_\_\_\_\_\_\_\_
In lactic acidosis, serum osmolarity is **normal**
49
What are blood glucose levels like in alcohol induced ketoacidosis?
Normal-high
50
What are the target and accepted blood glucose ranges for diabetic inpatients?
* Target level for glucose for hospital inpatients is 6-10mmol/L * 4-12mmol/L is accepted
51
What is foot CPR?
1. Check 2. Protect 3. Refer

The Endocrine System (35 decks)

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