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endocrine > diabetic emergencies > Flashcards

diabetic emergencies Flashcards

1
Q

what is diabetic ketoacidosis

A

Diabetic ketoacidosis (DKA) is 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

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2
Q

biochemical diagnosis of ketoacidosis

A
  • ketonaemia > 3mmol/L
  • blood glucose > 11mmol/L
  • bicarbonate < 15 mmol/L
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3
Q

reasons for increased insulin demand

A
  • infections
  • inflammatory
  • intoxication
  • infarction
  • iatrogenic

5 I’s

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4
Q

osmotic symptoms of DKA

A
  • thirst

- polyuria

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5
Q

ketone related symptoms of DKA

A
  • flushed
  • vomiting
  • abdo pain and tenderness
  • breathless
  • ketones in breath
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6
Q

conditions associated with DKA

A
  • underlying sepsis

- gastroenteritis

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7
Q

blood ketone level at ketosis

A

above 5

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8
Q

bicarbonate in severe cases of ketosis

A

<10

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9
Q

potassium in ketosis

A

above 5.5mmol/L

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10
Q

creatinine in DKA

A

raised

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11
Q

amylase in DKA

A

raised

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12
Q

sodium in DKA

A

low

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13
Q

management of DKA

A 
Replace losses (FIPP)
-Fluid, Initially with 0.9% sodium chloride, Glucose falls to about 15, switch to dextrose
-Insulin
-Potassium
-Phosphate [rarely] 
Address risks
-? is a naso-gastric tube required?
-Monitor K+
-Prescribe prophylactic LMWH
-Source sepsis: CXR, Blood Culture, MSSU +/- viral titres, etc.
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14
Q

IV fluid resuscitation treatment

A
  1. 1000mL NaCl 0.9% in first hour
  2. 2000mL NaCl by end of hour 2
  3. 3000mL NaCl by end of hour 4
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15
Q

what needs to be monitored in DKA

A
  • blood for U&E’s and bicarbonate level hour 2
  • blood for U&E’s and bicarbonate level 4
  • IV potassium replacement
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16
Q

how are ketones monitored

A
  • blood ketone monitoring

- urine ketone monitoring

17
Q

what does HHS stand for

A

hyperglycaemic hyperosmolar syndrome

18
Q

what is HHS

A

Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness.

19
Q

biochemical diagnosis of HHS

A
  • Hypovolaemia – usually marked
  • Marked hyperglycaemia > 30mmol/L
  • No/mild ketonaemia <3 mmol/L
  • Bicarbonate > 15 mmol /L or venous pH > 7.3
  • Osmolality >320 mosmol/kg
20
Q

who usually gets HHS

A

older patients

young afro-carribean

21
Q

what type of diabetes is HHS usually seen in

A

two

22
Q

what type of diabetes is DKA usually seen in

A

one

23
Q

what is the precipitant for HHS

A

new diagnosis infection

24
Q

treatment for HHS

A
  • use 0.9% saline for fluid replacement
  • start low dose IV insulin only if significant ketones or if BG falling at a slow rate
  • prophylactic fragmin
  • identify underlying precipitants
  • measure plasma osmality
  • assess severity of dehydration
25
Q

cause of HHS

A
  • diuretics or steroids

- fizzy drinks

26
Q

treatment for alcohol induced keto-acidosis

A
  • IV anti-emetics
  • IV Pabrinex
  • IV fluids

Am Pretty Fucked

-insulin may be required on occasion

27
Q

alcohol/starvation ketoacidosis biochemical diagnosis

A
  • dehydration
  • ketonaemia > 3mmol/L or significatn ketonuria
  • bicarbonate < 15mmol/L
  • venous pH < 7.3
  • glucose normal

same but normal glucose

28
Q

indications for hospital admission of type 1 diabetes

A
  • unable to tolerate oral fluids
  • persistant vomiting
  • persistent hyperglycaemia
  • positive/increasing level of ketones
  • abdo pain
  • breathlessness
29
Q

what is normal lactate range

A

0.6 to 1.2 mmol/L

30
Q

what is type A lactic acidosis

A

associated with tissue hypoxaemia

  • sepsis
  • haemorrhage
31
Q

type B lactic acidosis

A
  • liver disease
  • leukaemic states
  • diabetes
32
Q

clinical features of lactic acidosis

A
  • hyperventilation
  • mental confusion
  • stupor or coma if severe
33
Q

lab findings of lactic acidosis

A
  • reduced bicarbonate
  • absence of ketonaemia
  • raised anion gap
  • raised phosphate
34
Q

treatment for lactic acidosis

A
  • fluids

- antibiotics

endocrine (40 decks)

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