Diabetic Complications and Emergencies

Question 1

most common trigger of DKA?

Answer 1

inappropriate withdrawal of insulin

followed by infection and intoxication

Question 2

what level indicated ketonaemia?

Answer 2

over 3 mmol/ mol

Question 3

what pH indicated DKA?

what bicarb level?

Answer 3

below 7.3

below 15mmol

Question 4

where does ketogenesis occur?

Answer 4

the liver

Question 5

why do you obtain IV access in DKA?

Answer 5

1. baseline potassium
2. give fluids (saline first)
3. give slow bolus of insulin

Question 6

DKA is caused by low insulin plus high what?

Answer 6

stress hormones: GH, glucagon, adrenaline and cortisol

Question 7

complication of DKA in children / young adults?

Answer 7

cerebral oedema

Question 8

2 respiratory complications of DKA?

Answer 8

ARDS and aspiration pneumonia

Question 9

what is the severe hazard of having low K+ in DKA?

Answer 9

can trigger arthymias and cardiac arrest!!!!!

remember that insulin lowers K+

Question 10

typical HHS presentation:

• age
• drug history

Answer 10

old but may be 1st presentation of their T2DM

likely to be on Diuretics / steroids.

Question 11

describe levels in HSS…

• bp
• glucose
• ketones
• pH
• osmolarity?

Answer 11

low (hypovolaemic)
high glucose (over 30)
normal ketones
normal pH
high osmo (over 320 !! )

Question 12

what is the osmolarity calculation for HSS?

Answer 12

2 x [Na} + urea + glucose

Question 13

mortality in HHS?

why?

Answer 13

10-50%
older population
higher risk of vascular event and sepsis!!

Question 14

joey had a HHS event two weeks ago. what meds should be have been started on?

Answer 14

LMWH - risk of CV event

Better control of glucose

Question 15

what is the normal lactate range in mmol/ L ??

Answer 15

0.6 - 1.2

Question 16

does sepsis cause type A or B lactic acidosis?

Answer 16

type A - through hypovolaemic shock

other examples are infarcted bowel / cardiogenic shock

Question 17

diabetics get Type B lactic acidosis - who else does too?

Answer 17

liver disease patients

because hepatic conversion of lactate –> glucose cant occur well in disease liver tissue.

Question 18

what is bells palsy?

Answer 18

A focal neuropathy affecting the face. There is rapid weakness –> paralysis of one side. Lasts hours - days.

Question 19

why is there axon degeneration / demyelination in promimal neuropathy?

Answer 19

there is ischaemia due to microvascular insufficiencies.

Question 20

what nerves are affected in proximal neuropathy?

Answer 20

motor nerves of the lumbosacral plexus, typically the femoral nerve.

Question 21

in proximal neuropathy, which muscles waste?

Answer 21

iliopsoas
quads
hip adductors
There is weight loss in 50%.
occurs over months.

Question 22

what neuropathy causes gastroparesis?

Answer 22

autonomic

Question 23

what is the Tx for constipation in gastoparesis?

Answer 23

metoclopramide

Question 24

symptoms of autonomic neuropathy?

Answer 24

gastroparesis - bloat, vomiting. abdo pain.
constipation and or diarrhoea
difficulty swallowing
gustatory sweating!!!!

Question 25

what osmolarity level indicates HSS?

Answer 25

over 320 !!

Question 26

what complications are caused by chronic hyperglycaemia?

Answer 26

microvascular

- eyes, nerves and renal

Question 27

where does sorbitol come from, and what does it do?

Answer 27

Comes from: glucose converted by aldose reductase (when glucose conc is high)
Sorbitol exerts osmotic pressure which damages cells and vessels

Question 28

what do creatine levels of 5 indicate?

Answer 28

acute renal failure!

higher than 3

Question 29

what causes high interglomerular pressure?

Answer 29

microvascular damage to the kidneys with renal arteriole dilation.