diabetic emergencies Flashcards
what is the definition of DKA?
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. (e.g. glucagon, adrenaline)
what is glycosuria?
prescence of glucose in the urine due to it leaking out of the kidneys
what values are needed to diagnose DKA?
Ketonaemia > 3mmol /L, or significant ketonuria (>2+ on standard urine stick)
Blood glucose > 11.0 mmol /L or known DM (NB euglycaemic DKA).
Bicarbonate < 15 mmol /L or venous pH < 7.3
what are the leading causes of death due to DKA in children and adults?
children- cerebral oedema
adults- hypokalaemia
less common in adults are aspiration pneumonia, ARDS and co-morbidities
what are the 2 precipitants of DKA?
insulin deficiency (e.g. non adherence to insulin)
increased insulin demand (e.g. infection, inflammation)
what are the symptoms of DKA?
Vomiting
Dehydration
Increased heart rate
Distinctive acetone smell on breath
how do you treat DKA in hospital?
fluid resuscitation with NaCl
blood monitoring
potassium replacement if low
insulin
what is a normal blood ketone reading?
<0.6mmol/L
what type of diabetes is hyperglycaemic hyperosmolar syndrome more common in?
type 2
what are the diagnostic values of HHS?
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
what is the treatment for HHS?
Fluids:
More cautiously due to increased risk of fluid overload
Insulin:
More slowly as more sensitive (e.g. 3units/hour)
May not require any insulin.
Sodium:
Avoid rapid fluctuations – e.g. ≤0.5mmol/l/hr
May need to consider 0.45% Saline*
Co-morbidities more likely
Screen for vascular event (eg. silent MI), sepsis
LMWH for all unless contra-indicated
