Diabetes In Primary care Flashcards
1
Q
What is DKA?
A
Disordered metabolic state that usually occurs in the context of an absolute or relative insulin deficiency accompanied by an increase in the counter-regulatory hormones
2
Q
What does hyperglycemia lead to?
A
Glycosuria Osmotic diuresis Electrolyte loss Dehydration Decreased renal function
3
Q
What are the biochemical features associated with DKA?
A
Ketonaemia > 3mmol/l
Blood glucose > 11.0 mmol/l
Bicarbonate < 15mmol/l
4
Q
How can DKA lead to death?
A
Adults -Hypokalaemia -Aspiration Pneumonia -Co-morbidities Children -Cerebral Oedema
5
Q
What predisposes to DKA?
A
Newly diagnosed
Infection
Illicit drug and alcohol use
Non-adherence to insulin
6
Q
What are the signs and symptoms of DKA?
A
Thirst and polyuria Dehydration Flushed Vomiting Abdominal pain Tenderness Breathlessness Underlying sepsis Gastroenteritis
7
Q
What are the classical biochemisty signs at diagnosis?
A
Glucose Median level 40mmol/l From 11 to > 100 Potassium Raised above 5.5 mmol Beware of a low reading Creatinine -Often raised SOdium Often low Raised lactate is common Blood ketones usually above 5 Bicarbonate <10 in severe cases Amylase often raised Median WC of 25
8
Q
What are the management principles of DKA?
A
Manage in HDU Replace fluid, insulin, potassium and phosphate loss Address risks -NG tube Monitor K+ Prescrive prophylactic LMWH Source sepsis: CXR Blood Culture, MSSU
9
Q
What level of blood ketone is normal?
A
<0.6mmol/L
10
Q
What is the biochemical diagnosis of HHS?
A
Marked hypovolaemia Marked Hyperglycaemia > 30mmol/L Mind ketonaemia <3mmol/l Bicarbonate > 15mmol/L or venous pH >7.3 Osmolality > 320 mosmol/kg
