Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics II > Diabetic Emergencies > Flashcards

Diabetic Emergencies Flashcards

1
Q

What can cause diabetic ketoacidosis?

A

-Hyperglycemia
-Hyperketonemia
-Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What can cause hyperglycemic hyperosmolar state?

A

-Severe hyperglycemia
-Hyperosmolality
-Severe fluid depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the pathophysiology surrounding DKA and HHS?

A

The basic underlying mechanism for both disorders is a reduction in the net effective action of circulating insulin coupled with concomitant elevation of counterregulatory hormones, such as glucagon, catecholamines, cortisol, and growth hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of diabetes typically experiences DKA?

A

It usually occurs in T1DM or new-onset T2DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the leading precipitating factors of DKA?

A

-Poor adherence to treatment regimen
-Infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which drugs can cause DKA?

A

-Thiazides
-Steroids
-Sympathomimetics
-Atypical antipsychotics
-SGLT2 inihibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of DKA

A

-Polyuria, polydipsia, weight loss, dehydration
-Nausea/vomiting (40-75% of patients)
-Abdominal pain (40-75% of patients)
-Changes in mental status
-Fruity breath
-Kussmaul respirations
-Coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Glucose level in mild DKA

A

Over 250

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Blood pH in mild DKA

A

7.25-7.3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Bicarbonate level in mild DKA

A

15-18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anion gap in mild DKA

A

Over 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Glucose level in moderate DKA

A

Over 250

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Blood pH in moderate DKA

A

7-7.24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bicarbonate level in moderate DKA

A

10-14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anion gap in moderate DKA

A

Over 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Glucose level in severe DKA

A

Over 250

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Blood pH in severe DKA

A

Less than 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Bicarbonate level in severe DKA

A

Less than 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Anion gap in severe DKA

A

Over 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

DKA triad

A

-Hyperglycemia
-Hyperketonemia
-Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Goals of treatment for DKA

A

-Restore circulatory volume (Fluids)
-Inhibit ketogenesis and return to normal glucose metabolism (insulin)
-Correct electrolyte imbalances (supplement electrolytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How to restore circulatory volume in DKA

A

-Administer 0.9% sodium chloride at 500-1000 mL/hr for first 1-4 hours
-Evaluate corrected Na at 2-4 hours
- If corrected Na is normal/high: change to 1/2 NS and decrease the rate by 50%
-If corrected NA is low: continue NS and decrease the rate by 50%
-When blood glucose approaches 200mg/dL, change to D5W w/ 1/2 NS @150-250 mL/hr until resolution of ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you find corrected sodium?

A

measured sodium + 1.6[(glucose - 100)/100]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When do you initiate insulin therapy in patients with DKA?

A

Insulin therapy is the second step in the management of DKA after fluids are initiated

25
Q

What is the preferred way to administer insulin for patients with DKA?

A

IV continuous infusion is preferred but can also be SubQ or IM

26
Q

How do you dose insulin for patients with DKA?

A

-Start 0.1 units/kg/hour +/- a bolus of 0.1 units/kg
-Check glucose every hour
-If glucose does not fall by 10% or more in first hour, give, repeat, or increase bolus dose (0.1-0.14 units/kg)

27
Q

When do you transition to SubQ insulin from IV in patients with DKA?

A

-When the blood glucose level is less than 200
-Meets at least 2 of the following criteria
-Anion gap closes at 12 mEq/L or less
-Bicarbonate level is 15 mEq/L or more
-Venous pH is greater than 7.3
Ideally the patient should be able to eat

28
Q

How do you dose SubQ insulin for patients with DKA and HHS?

A

-You can restart home regimen if it was working previously
-Consider SubQ rapid-acting insulin every 2 hours at 0.1 units/kg adjusted as needed to maintain goal
-If the patient is insulin-Naive, start multidose regimen of 0.5-0.8 units/kg/day, divided 50/50 basal/bolus
-Consider adding up the total amount of IV insulin required by patient and convert to estimated daily requirement using basal/bolus or every 6 hour NPH

29
Q

What should you always do when switching from IV insulin to SQ insulin to prevent rebound ketoacidosis or hyperglycemia?

A

Overlap IV and SQ insulin by 2-4 hours

30
Q

What are the electrolytes of concern when it comes to DKA?

A

-Potassium
-Sodium
-Phosphate
-Anion gap

31
Q

What are some pertinent lab values to consider when treating someone with DKA?

A

-pH
-SCr
-WBC

32
Q

How do you calculate anion gap?

A

Na - (chloride + bicarbonate)

33
Q

What anion gap suggests metabolic acidosis?

A

A gap of greater than 12 mEq/L

34
Q

At what anion gap level can you consider transitioning from IV insulin to SQ insulin?

A

At a gap of less that 12

35
Q

What K level do you want to maintain in DKA?

A

Maintain a K of 4-5 mmol/L

36
Q

What K level can you not start insulin?

A

Do not start insulin if K is less than 3.3mmol/L

37
Q

What should you do when a DKA patient has a K level greater than 5?

A

No supplementation

38
Q

What should you do when a DKA patient has a K level between 4-5?

A

Add 20 mEq KCl per liter to replacement fluids

39
Q

What should you do when a DKA patient has a K level between 3-4?

A

Add 40 mEq KCl per liter to replacement fluids

40
Q

What should you do when a DKA patient has a K level below 3?

A

Add 10-20 mEq/hour until K is greater than 3, then supplement 40 mEq

41
Q

How do you treat DKA patients with abnormal phosphate levels?

A

-Phosphate concentration decreases with insulin therapy, but no studies have suggested benefit in replacing phosphate acutely
-May be supplemented as potassium phosphate in fluids in patients presenting with a phosphate level lower than 1 and comorbidities such as anemia, cardiac dysfunction, or respiratory depression

42
Q

At what pH is bicarb supplementation recommended?

A

Less than 6.9

43
Q

How do you supplement bicarb in DKA patients?

A

Give 50-100 mmol bicarb every 1-2 hours until pH is 7 or greater

44
Q

How should serum creatinine abnormalities be treated in DKA patients?

A

Should improve as fluids replaced

45
Q

How should increased white blood cell count be treated in DKA patients?

A

Likely do not need antibiotics unless showing other signs or symptoms of infection

46
Q

At what WBC level is it more indicative of an infection?

A

WBC greater than 25,000

47
Q

Precipitating factors of HHS

A

Heart attack, stroke, infection, recent procedure

48
Q

What kind of patients does HHS typically occur in?

A

-Older adults
-Many patients have underlying heart failure or kidney disease

49
Q

Symptoms of HHS

A

-Polyuria
-Polydipsia
-Dehydration w/ reduced fluid intake
-Lethargy
-Confusion
-Coma
-Seizures

50
Q

Typical glucose level in HHS patients

A

~800-2400

51
Q

Typical BUN in HHS patients

A

Often severely elevated > 100mg/dL

52
Q

Typical serum osmolality in HHS patients

A

over 320

53
Q

How do you calculate osmolality in HHS patients?

A

(Nax2) + (BUN/2.8) + (glucose/18)

54
Q

Goals of treatment for HHS

A

-Restore circulatory volume (fluids)
-Restore urine output to 50 mL/hour or more (fluids)
-Return blood glucose to normal (fluids + insulin)

55
Q

Fluid treatment for HHS

A

-Administer 1/2 NS or NS at 500-1000 mL/hr for first 1-4 hours
-Evaluate corrected Na at 2-4 hours
-If corrected Na normal/high: reduce the rate
-If corrected Na low: consider NS
-When blood sugar is 300 mg/dL, change to D5W w/ 1/2 NS @ 150-250 mL/hr until resolution of HHS

56
Q

Goal blood sugar for DKA

A

200

57
Q

Goal blood sugar for HHS

A

300

58
Q

Insulin treatment for HHS

A

-Start 0.1 units/kg/hour +/- a bolus of 0.1 units/kg
-Check glucose every hour and adjust dose of insulin to obtain an initial glucose goal of 300
-Then decrease infusion to 0.02-0.05 units/kg/hour and maintain glucose of 200-300 mg/dL until patient is mentally alert
-Once mentally alert, transition to SQ insulin (with overlap)

Therapeutics II (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions