Diabetic Complications and Emergencies Flashcards
most common trigger of DKA?
inappropriate withdrawal of insulin
followed by infection and intoxication
what level indicated ketonaemia?
over 3 mmol/ mol
what pH indicated DKA?
what bicarb level?
below 7.3
below 15mmol
where does ketogenesis occur?
the liver
why do you obtain IV access in DKA?
- baseline potassium
- give fluids (saline first)
- give slow bolus of insulin
DKA is caused by low insulin plus high what?
stress hormones: GH, glucagon, adrenaline and cortisol
complication of DKA in children / young adults?
cerebral oedema
2 respiratory complications of DKA?
ARDS and aspiration pneumonia
what is the severe hazard of having low K+ in DKA?
can trigger arthymias and cardiac arrest!!!!!
remember that insulin lowers K+
typical HHS presentation:
- age
- drug history
old but may be 1st presentation of their T2DM
likely to be on Diuretics / steroids.
describe levels in HSS…
- bp
- glucose
- ketones
- pH
- osmolarity?
low (hypovolaemic) high glucose (over 30) normal ketones normal pH high osmo (over 320 !! )
what is the osmolarity calculation for HSS?
2 x [Na} + urea + glucose
mortality in HHS?
why?
10-50%
older population
higher risk of vascular event and sepsis!!
joey had a HHS event two weeks ago. what meds should be have been started on?
LMWH - risk of CV event
Better control of glucose
what is the normal lactate range in mmol/ L ??
0.6 - 1.2
does sepsis cause type A or B lactic acidosis?
type A - through hypovolaemic shock
other examples are infarcted bowel / cardiogenic shock
diabetics get Type B lactic acidosis - who else does too?
liver disease patients
because hepatic conversion of lactate –> glucose cant occur well in disease liver tissue.
what is bells palsy?
A focal neuropathy affecting the face. There is rapid weakness –> paralysis of one side. Lasts hours - days.
why is there axon degeneration / demyelination in promimal neuropathy?
there is ischaemia due to microvascular insufficiencies.
what nerves are affected in proximal neuropathy?
motor nerves of the lumbosacral plexus, typically the femoral nerve.
in proximal neuropathy, which muscles waste?
iliopsoas quads hip adductors There is weight loss in 50%. occurs over months.
what neuropathy causes gastroparesis?
autonomic
what is the Tx for constipation in gastoparesis?
metoclopramide
symptoms of autonomic neuropathy?
gastroparesis - bloat, vomiting. abdo pain.
constipation and or diarrhoea
difficulty swallowing
gustatory sweating!!!!
what osmolarity level indicates HSS?
over 320 !!
what complications are caused by chronic hyperglycaemia?
microvascular
- eyes, nerves and renal
where does sorbitol come from, and what does it do?
Comes from: glucose converted by aldose reductase (when glucose conc is high)
Sorbitol exerts osmotic pressure which damages cells and vessels
what do creatine levels of 5 indicate?
acute renal failure!
higher than 3
what causes high interglomerular pressure?
microvascular damage to the kidneys with renal arteriole dilation.
