Diabetic Emergencies Flashcards
what is hypoglycaemia
low blood glucose
what is the most common side effect of insulin therapy
hypoglycaemia
when does hypoglycaemia occur
more insulin injected than is needed
irregular eating habits, unusual exertion and alcohol excess
what times are you at greatest risk of hypoglycaemia
before meals, during the night or during or after exercise
what is the greatest diabetic-related risk of hypoglycaemia
prior episode of severe hypoglycaemia
who is the most at risk for severe hypoglycaemia
young people. low socioeconomic status, comorbidity, use of anti-depressants, people with fear of hyperglycaemia
clinical presentation of hypoglycaemia
pallor, sweating, tremor, palpitations, confusion, nausea, hunger
how is hypoglycaemia classified
level 1-3
level 1 hypoglycaemia
glucose alert level of 3.9 or less
level 2 hypoglycaemia
glucose level <3
level 3 hypoglycaemia
severe, cognitive impairment, requires external assistance for recovery
management of severe hypoglycaemia
IM glucagon or IV glucose
management of hypoglycaemia
15-20g oral glucose
what is DKA
diabetic ketoacidosis
what type of diabetes is commonly associated with DKA
T1DM
what are the 2 general causes of DKA
insulin deficiency
increased insulin demand
5 I causes of increased insulin demand
infections, inflammation, intoxication, infarction or iatrogenic
where are ketone bodies formed
in liver mitochondria
what are ketone bodies formed from
acetyl-CoA
why is insulin needed to prevent the formation of ketone bodies
inhibits lipolysis
pathophysiology of DKA
lack of insulin means the amount of glucose taken up from the blood into tissues and amount of glycolysis will reduce, so body switches to fatty acid oxidation
consequences of accumulation of ketone bodies
acidosis
high glucose excretion causes osmotic diuresis, causing electrolyte loss and dehydration -> decreases renal function and exacerbates acidosis
osmotic related symptoms of DKA
thirst and polyuria
dehydration
ketone body related symptoms of DKA
vomiting
flushing
abdominal pain and tenderness
increased resp rate
pear drop smell on breath
resp sign associated with DKA
kussmaul’s respiration
what is kussmaul’s respiration
deep, rapid breathing pattern
(hyperventilation)
diagnosis of DKA
hyperglycaemia with ketonemia or heavy ketonuria and acidosis
investigations which show acidosis in DKA
bicarbonate < 18, venous pH <7.3
other biochemistry signs of DKA
hypokalaemia
creatinine raised
sodium low
amylase raised
white cell count raised
management of DKA
fluid replacement
replace electrolytes
restore acid-base balance (usually compensated on its own fairly quickly)
insulin replacement
MONITORING
name 3 complications of DKA
cerebral oedema
aspiration pneumonia
ARDS
what is hyperglycaemic hyperosmolar syndrome commonly associated with
T2DM
what is hyperglycaemic hyperosmolar syndrome
severe hyperglycaemia without significant ketosis
when do people present with hyperglycaemic hyperosmolar syndrome
middle age with previously undiagnosed diabetes
state 3 common precipitants of hyperglycaemic hyperosmolar syndrome
consumption of glucose rich foods, concurrent medications (thiazide, steroids) and intercurrent illness
what causes hyperglycaemic hyperosmolar syndrome to differ from DKA
small amounts of insulin is secreted by the pancreas
clinical presentation of hyperglycaemic hyperosmolar syndrome
dehydration due to polyuria
polydipsia
N+V
stupor/coma
what is stupor
decreased level of consciousness
how is hyperglycaemic hyperosmolar syndrome diagnosed
profound hyperglycaemia
hyperosmolarity
volume depletion in the absence of ketoacidosis
management of hyperglycaemic hyperosmolar syndrome
fluid replacement without insulin
only start insulin if significant ketones
what is alcoholic ketoacidosis
increased production of ketones with normal or low glucose as a result of excess alcohol and starvation
who usually gets alcoholic ketoacidosis
malnourished individuals with AUD
what is associated with alcoholic ketoacidosis
recent episodes of binge drinking complicated by poor food intake, dehydration and vomiting
clinical presentation of alcoholic ketoacidosis
N+V
abdo pain
increased resp rate
dehydration
management of alcoholic ketoacidosis
IV pabrinex (high dose vitamins including thiamine)
IV fluid, anti-emetics
insulin if required
