Diabetic Emergencies

Question 1

in which type of DM is diabetic ketoacidosis most common in?

Answer 1

type 1 DM

Question 2

what is the most common cause of DKA?

Answer 2

poor compliance

Question 3

what does insulin encourage? (2)

Answer 3

uptake of glucose in muscle and adipose tissue

uptake of ions (K)

Question 4

what does insulin stop? (3)

Answer 4

glucogenesis
lipolysis
ketogenesis

Question 5

a patient presents with polyuria, polydipsia, fatigue, nausea/vomiting, kussmaul respirations, abdominal tenderness, and fruity breath/acetone. what is the patient experiencing?

Answer 5

DKA

Question 6

deep hyperventilation in an effort to put the body into respiratory alkalosis to fight against the metabolic acidosis state

Answer 6

kussmaul respirations

Question 7

a patient with DKA starts as stupor or drowsiness, but can progress to _____

Answer 7

coma

Question 8

in DKA, initial evaluation must be rapid to assess: (4)

Answer 8

ABCs
mental status
precipitating events
volume status

Question 9

what will labs for DKA look like?
serum glucose, pH, bicarb, ketones, anion gap

Answer 9

serum glucose 350-500
serum pH < 7.3
serum bicarb < 15 (low)
serum ketones > 3
increased anion gap

Question 10

a patient is in DKA with K less than 3.3. what is the treatment? (2)

Answer 10

IV fluids
K

Question 11

a patient is in DKA with normal K and pH less than 6.9. what is the treatment? (3)

Answer 11

IV fluids
insulin IV push and drip
sodium bicarb

Question 12

what is an important step in treatment for DKA and HHS?

Answer 12

treat the associated infection or cause

Question 13

how would we want to change the treatment of DKA and HHS, in regards to insulin?

Answer 13

transition from IV insulin to subQ insulin

Question 14

why do we NOT want to give a patient in DKA insulin if they have a K less than 3.3?
what can it lead to?

Answer 14

more insulin pushes K into cells, causing more hypokalemia
can lead to arrhythmia

Question 15

a patient has pH between 7.25-7.3 and are alert. what is their severity of DKA?
what is their disposition?

Answer 15

mild
ED

Question 16

a patient has pH between 7.0-7.24 and is alert/mild drowsiness. what is their severity of DKA?
what is their disposition?

Answer 16

moderate
step down unit or ICU for 1 night

Question 17

a patient has pH less than 7 and are stuporous. what is their severity of DKA?
what is their disposition?

Answer 17

severe
ICU

Question 18

in which type of DM is hyperosmolar hyperglycemic state most common in?

Answer 18

type 2 DM

Question 19

hyperglycemia state without ketosis

Answer 19

hyperosmolar hyperglycemic state

Question 20

what 2 conditions are common in a hyperosmolar hyperglycemic state?

Answer 20

chronic kidney disease
heart failure

Question 21

a patient presents with history of infection/MI/stroke/surgery and has polyuria, polydipsia, fatigue/weakness, dehydration, and progressive confusion. what are they experiencing?

Answer 21

hyperosmolar hyperglycemic state

Question 22

what will labs in a hyperosmolar hyperglycemic state look like?
glucose, pH, bicarb, and anion gap

Answer 22

serum glucose over 1,000
serum pH > 7.3
serum bicarb > 15
normal anion gap

Question 23

why is serum glucose in a hyperosmolar hyperglycemic state frequently over 1,000 and usually around 600?

Answer 23

can tolerate high levels of glucose because some insulin is present

Question 24

a patient is in a hyperosmolar hyperglycemic state with K less than 3.3. what is the treatment? (2)

Answer 24

IV fluids
K

Question 25

a patient is in a hyperosmolar hyperglycemic state with normal K levels. what is the treatment? (2)

Answer 25

IV fluids
insulin IV push and drip