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endocrine > Diabetic Emergencies > Flashcards

Diabetic Emergencies Flashcards

1
Q

what is hypoglycaemia

A

low blood glucose

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1
Q

what is the most common side effect of insulin therapy

A

hypoglycaemia

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2
Q

when does hypoglycaemia occur

A

more insulin injected than is needed
irregular eating habits, unusual exertion and alcohol excess

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3
Q

what times are you at greatest risk of hypoglycaemia

A

before meals, during the night or during or after exercise

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4
Q

what is the greatest diabetic-related risk of hypoglycaemia

A

prior episode of severe hypoglycaemia

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5
Q

who is the most at risk for severe hypoglycaemia

A

young people. low socioeconomic status, comorbidity, use of anti-depressants, people with fear of hyperglycaemia

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6
Q

clinical presentation of hypoglycaemia

A

pallor, sweating, tremor, palpitations, confusion, nausea, hunger

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7
Q

how is hypoglycaemia classified

A

level 1-3

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8
Q

level 1 hypoglycaemia

A

glucose alert level of 3.9 or less

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9
Q

level 2 hypoglycaemia

A

glucose level <3

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10
Q

level 3 hypoglycaemia

A

severe, cognitive impairment, requires external assistance for recovery

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11
Q

management of severe hypoglycaemia

A

IM glucagon or IV glucose

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12
Q

management of hypoglycaemia

A

15-20g oral glucose

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13
Q

what is DKA

A

diabetic ketoacidosis

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14
Q

what type of diabetes is commonly associated with DKA

A

T1DM

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15
Q

what are the 2 general causes of DKA

A

insulin deficiency
increased insulin demand

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16
Q

5 I causes of increased insulin demand

A

infections, inflammation, intoxication, infarction or iatrogenic

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17
Q

where are ketone bodies formed

A

in liver mitochondria

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18
Q

what are ketone bodies formed from

A

acetyl-CoA

19
Q

why is insulin needed to prevent the formation of ketone bodies

A

inhibits lipolysis

20
Q

pathophysiology of DKA

A

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

21
Q

consequences of accumulation of ketone bodies

A

acidosis
high glucose excretion causes osmotic diuresis, causing electrolyte loss and dehydration -> decreases renal function and exacerbates acidosis

22
Q

osmotic related symptoms of DKA

A

thirst and polyuria
dehydration

23
Q

ketone body related symptoms of DKA

A

vomiting
flushing
abdominal pain and tenderness
increased resp rate
pear drop smell on breath

24
Q

resp sign associated with DKA

A

kussmaul’s respiration

25
Q

what is kussmaul’s respiration

A

deep, rapid breathing pattern
(hyperventilation)

26
Q

diagnosis of DKA

A

hyperglycaemia with ketonemia or heavy ketonuria and acidosis

27
Q

investigations which show acidosis in DKA

A

bicarbonate < 18, venous pH <7.3

28
Q

other biochemistry signs of DKA

A

hypokalaemia
creatinine raised
sodium low
amylase raised
white cell count raised

29
Q

management of DKA

A

fluid replacement
replace electrolytes
restore acid-base balance (usually compensated on its own fairly quickly)
insulin replacement
MONITORING

30
Q

name 3 complications of DKA

A

cerebral oedema
aspiration pneumonia
ARDS

31
Q

what is hyperglycaemic hyperosmolar syndrome commonly associated with

A

T2DM

32
Q

what is hyperglycaemic hyperosmolar syndrome

A

severe hyperglycaemia without significant ketosis

33
Q

when do people present with hyperglycaemic hyperosmolar syndrome

A

middle age with previously undiagnosed diabetes

34
Q

state 3 common precipitants of hyperglycaemic hyperosmolar syndrome

A

consumption of glucose rich foods, concurrent medications (thiazide, steroids) and intercurrent illness

35
Q

what causes hyperglycaemic hyperosmolar syndrome to differ from DKA

A

small amounts of insulin is secreted by the pancreas

36
Q

clinical presentation of hyperglycaemic hyperosmolar syndrome

A

dehydration due to polyuria
polydipsia
N+V
stupor/coma

37
Q

what is stupor

A

decreased level of consciousness

38
Q

how is hyperglycaemic hyperosmolar syndrome diagnosed

A

profound hyperglycaemia
hyperosmolarity
volume depletion in the absence of ketoacidosis

39
Q

management of hyperglycaemic hyperosmolar syndrome

A

fluid replacement without insulin
only start insulin if significant ketones

40
Q

what is alcoholic ketoacidosis

A

increased production of ketones with normal or low glucose as a result of excess alcohol and starvation

41
Q

who usually gets alcoholic ketoacidosis

A

malnourished individuals with AUD

42
Q

what is associated with alcoholic ketoacidosis

A

recent episodes of binge drinking complicated by poor food intake, dehydration and vomiting

43
Q

clinical presentation of alcoholic ketoacidosis

A

N+V
abdo pain
increased resp rate
dehydration

44
Q

management of alcoholic ketoacidosis

A

IV pabrinex (high dose vitamins including thiamine)
IV fluid, anti-emetics
insulin if required

endocrine (15 decks)

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