Diabetic Emergencies

Question 1

What is Kussmaul respiration?

Answer 1

Deep ‘sighing’ respirations secondary to metabolic acidosis

Question 2

What percentage of T1DM patients first present with DKA?

Answer 2

20-25%

Question 3

Name three precipitants of DKA.

Answer 3

• Infection
• D&V
• MI

Question 4

What are two key respiratory exam findings in DKA?

Answer 4

• Kussmaul breathing
• Sweet / fruity breath odour

Question 5

List four cardiovascular exam findings in DKA.

Answer 5

• Tachycardia
• HoTN
• Dry mucous membranes

Question 6

What is a common abdominal exam finding in DKA?

Answer 6

Absent bowel sounds

Stomach bubble (ketones suppress peristalsis leading to gastroparesis)

Question 7

What are the three criteria for diagnosing DKA?

Answer 7

• Hyperglycaemia >11.1
• Ketones >3.0 or ketonuria
• Acidosis pH <7.35 (bicarbonate <15 mmol/L)

Question 8

What blood tests are commonly performed in DKA?

Answer 8

• FBC
• U&E (Hyperkalaemia+ Hypercalcemia (acidosis displaces Ca2+ from albumin))
• LFTs
• CRP (infection is a possible trigger)
• Glucose
• HbA1c
• VBG (ketones)

Question 9

What is the significance of anion gap in DKA?

Answer 9

High anion gap metabolic acidosis indicates DKA

Question 10

True or False: DKA is a hypercoagulable state.

Answer 10

True

Question 11

What is the fluid treatment for DKA?

Answer 11

1L 0.9% NaCl STAT

Question 12

What is part of DKA treatment protocol?

Answer 12

Question 13

What are the targets in DKA management?

Answer 13

■ Reduce ketones by 0.5 mmol/hr

■ Reduce glucose by 3 mmol/hr

■ Increase bicarbonate by 3 mmol/hr

■ Keep K+ in the range of [4.5-5.0]

Question 14

What is a potential complication of DKA treatment in children?

Answer 14

Cerebral oedema

Question 15

What to monitor for in DKA?

Answer 15

Question 16

What is the role of C-peptide in diagnosing T1DM?

Answer 16

C-peptide levels are low in T1DM

Question 17

Name two diabetes-specific autoantibodies associated with T1DM.

Answer 17

• Islet cell antibodies
• Insulin autoantibodies

Question 18

What is the recommended frequency for monitoring neuro observations in DKA treatment?

Answer 18

Every 30 mins until GCS at baseline, then less frequently

Question 19

What is the mortality rate associated with HHS?

Answer 19

Up to 20%

HHS stands for Hyperglycemic Hyperosmolar State.

Question 20

What results from hyperglycemia in HHS?

Answer 20

Osmotic diuresis, severe dehydration, and electrolyte deficiencies.

Question 21

Who typically presents with HHS?

Answer 21

Elderly T2 diabetics.

Question 22

What are common precipitating factors for HHS?

Answer 22

• Intercurrent illness
• Dementia
• Sedative drugs

Question 23

What symptoms are associated with HHS?

Answer 23

• Polydipsia & polyuria
• Lethargy
• Nausea & vomiting

Question 24

How does the chronicity of symptoms differ between DKA and HHS?

Answer 24

DKA presents within hours, whereas HHS develops over many days.

Question 25

What neurological signs may be present in HHS?

Answer 25

* Altered level of consciousness * Focal neurological deficits

Question 26

What are the typical investigations used in HHS diagnosis?

Answer 26

* Hypovolaemia * Marked hyperglycaemia (>30 mmol/L) * Raised serum osmolarity (>320 mosmol/kg) * No significant hyperketonemia (<3 mmol/L) * No significant acidosis (bicarbonate >15 mmol/L or pH >7.3)

Question 27

What intravenous fluid is used for treatment in HHS?

Answer 27

IV 0.9% NaCl.

Question 28

What is the recommended rate for IV fluid administration in HHS?

Answer 28

0.5-1.0 L/hr depending on clinical assessment.

Question 29

When should insulin be administered in HHS treatment?

Answer 29

Only if blood glucose stops falling while giving IV fluids.

Question 30

What prophylaxis should be considered in HHS treatment?

Answer 30

VTE prophylaxis with LMWH.

Question 31

What investigations are included in blood tests for HHS?

Answer 31

* FBC * U&E * CRP * Glucose