Diabetes Emergencies Flashcards
blood glucose of what level results in hypoglycaemia
<4mmol/L
what are the causes of hypoglycaemia
alcohol excess
excess insulin
acute illness eg sepsis
insulinoma
how does hypoglycaemia present
sweating anxiety hunger nausea palpitation confusion loss of awareness visual disturbances seizures coma
what investigations are carried out for suspected hypo
ABCDE
finger prick glucose
FBC, U&Es, LFTs glucose
what is the management of hypoglycaemia
if conscious give 15-20g of fast acting glucose tablets or gel
if unconscious give IV glucose over 10 minutes of varying percentages
how does DKA arise
ketones are produced in the liver, when they are overproduced in excessive fat breakdown acidosis occurs
what is DKA
state of insulin deficiency resulting in hyperglycaemia and dehydration
state the biochemical markers of DKA
hyperglycaemia
ketonaemia
high anon gap acidosis
what are the causes of DKA
drugs and alcohol
undiagnosed T1DM
non-compliance with insulin
acute illness
how does DKA present
lethargy and confusion
abdo pain and vomiting
polydipsia and polyuria
what are the signs of DKA on examination
reduced GCS
deep sighing breathing
sweet smelling breath
dehydration
what investigations are carried out for suspected DKA
ABCDE
finger prick for glucose and ketones
bloods - FBC, venous pH, bicarbonate, glucose, osmolality
state the levels of glucose, ketones and pH for diagnosis of DKA
glucose >11
ketones >3
pH acidosis <7.35
how is DKA managed
fluid resuscitation
IV insulin 0.1unit/kg/hour
monitor potassium
what are the complications of DKA
cerebral oedema
hypokalaemia
ARDS
aspiration
how does cerebral oedema present
headache
recurrent vomiting
incontinence
reducing GCS
what is hyperglycaemic hyperosmolar syndrome
emergency in T2DM only where severe uncorrected hyperglycaemia results in dehydration
what is the presentation of HSS
similar to DKA except usually a slower presentation, onset of symptoms is days to weeks
what is the management of HSS
start insulin
monitor U&Es and glucose
monitor for events such as stroke
what causes lactic acidosis
sepsis
complication of DKA
use of metformin in DKA
what will bloods look like in lactic acidosis
lactate >5
raised phosphate
pH <7.35 and reduced bicarbonate
how is lactic acidosis managed
fluid resuscitation
bicarbonate infusion
treat underlying cause
