Diabetic emergencies Flashcards
What is needed to diagnose diabetic ketoacidosis?
Ketonaemia of over 3mmol/l or 2+ ketonuria or a result of 2+ on a standard urine stick
Bloood glucoseof over 11mmol/l or known diabetes
Bicarbonate of under 15mmol/l or venous pH of under 7.3
Levels of what hormones increase when the body is in DKA?
Glucagon, adrenaline, cortisol and growth hormone
What bicochemical markers are usually high when a patient comes in with DKA?
Potassium
Lactate
Creatinine
What biochemical marker is usually low in DKA?
Sodium
Describe what usually happens to sodium and potassium in DKA?
High potassium (above 5.5) and low sodium
What substance do you measure in the blood to meausure ketones?
Beta hydroxybutarate
Are bicarbonate levels low or high in DKA?
Low
How would you manage DKA?
- 0.9% saline
- If glucose falls to 15 switch to dextrose - Insulin
- Potassium
(4) Sometimes phsophate
- Monitor potassium
Heparin
How long do you give saline over and how much do you give for DKA?
1L 0.9% over 1hr
How much insulin fo you want to give for a patient in DKA
6units/hour IV soluble insulin
What does the pottassium need to be under in order for you to give pottassium in DKA?
5mmol/L
If the blood glucose falls to below 14 in the first four hours of DKA treatment, what do you do?
Give glucose 10% 500ml with 20mmol KCl at 100ml/hour
Reduce insulin to 3 units an hour
What do you want to maintain the blood sugar at in treatment of DKA?
Between 9 and 14
What does urinary ketones measure?
Acetoacetate
On biochemistry a diabeteic patient has a high ion gap yet low ketone levels
Lactic acidosis
How do you get type A lactic acidosis?
Tissue hypoxaemia eg ischaemic bowel, sepsis
What drugs could cause lactic acidosis in diabetic patients?
Metformin
Is type A or type B lactic acidosis most associated with diabetes?
Type B
What is the equation to work out a raised ion gap?
[(Na+ + K+) – (HCO3 + Cl-)]
What are the phosphate levels like in lactic acidosis?
Raised
What medication increase the risk of hyperosmolor hyperosmotic syndrome?
Glucocorticoids and thiazides
A 78 year old lady.
Practice phoned by relatives asking for a home visit. Known metastatic breast cancer with increasing confusion over a week. History of diet-controlled type 2 diabetes.
morphine, dexamethasone [recently started]
BM when visited – “HI” on meter
Hyperglycaemic hyperosmolar syndrome
How high in the glucose in HHS?
Very high; often above 60
What is the usual osmolality in HHS?
400
How do you treat HHS?
Slowly give fluids
Give insulin at 3 units per hour
Monitor sodium
Is sodium usually high or low in HHS?
High
What is the main worry with HHS?
Cerebral oedema
