Diabetic emergencies 2 (ignore) Flashcards
What is the diagnosis of HHS based on ?
- Hypovolaemia (hypotension)
- Marked hyperglycaemia > 33/35
- Osmolality > 320
What is lactic acidosis in terms of biochemistry ?
Blood lactate > 5 mmol/L and pH acidotic
What are normal blood lactate levels ?
0.6-1.2 mmol/L
Describe the pathophysiology of lactic acidosis ?
Lactate is the end product of anaerobic metabolism of glucose
When else could lactate levels be raised ?
- In severe exercise lactate can be up to 10 mmol/L. So important not to confuse hyperlactaemia with lactic acidosis
- It is also often raised in DKA
What are some of the potential causes of lactic acidosis (type A, type B we don’t really need to know)?
- Infarcted tissue e.g. ischaemic bowel
- Cardiogenic shock
- Hypovolaemic shock
- Sepsis (endotoxic shock)
- Haemorrhage
- Metformin
What are the symptoms of lactic acidosis ?
- Hyperventilation
- Mental confusion
- Stupor or coma if severe
What is the anion gap and its normal range ?
Normal range is 10-18 mmol/L
It is an equation useful in determining the cause of an acidosis:
i.e. those conditions with a normal anion gap and those with a high anion gap.
What are the typical biochemistry of lactic acidosis?
- Decreased HCO3-
- Raised anion gap
- Glucose most often raised
- Lactate > 5 mmol/L
- Absence of ketonaemia
- Increased Phosphate
What is the treatment of lactic acidosis ?
- Treat underlying condition
- Withdraw offending medication if needed
- Give fluids
- Antibiotics if needed e.g. if caused by sepsis
What is the treatment of alcohol induced DKA?
- Pabrinex – high dose vitamins.
- IV fluids particularly dextrose.
- On occasion insulin may be required
Review this summary slide
What is the target range of glucose in hospital ?
6-10 mmol/L, although accept 4-12 mmol/L
