Diabetic Emergencies

Question 1

what size catheter average for adult male?

Answer 1

14-16 with 10cc balloons

Question 2

3 things to remember when catheterizing?

Answer 2

1. don’t push if much resistance
2. don’t inflate balloon until you get urine return
3. look at their facial expressions

Question 3

KETONE LEVELs in blood usually how much? How much is bad?

Answer 3

1.5 mmol is bad

Question 4

what is the top 3 causes of ketoacidosis?

Answer 4

1. Inappropriate insulin therapy
2. new onset DM1
3. alcohol abuse

Question 5

3 kinds of infections that can cause ketoacidosis?

Answer 5

pneumonia
speticaemia
UTI

Question 6

4 principles of ketoacidosis treatment?

Answer 6

1. rehydration
2. correct electrolytes (Potassium)
3. insulin therapy (after K+ levels are WNL)
4. search for underlying cause

Question 7

what do you use for ketoacidosis rehydration? any changes to the fluids once the glucose decreases?

Answer 7

Normal Saline (according to cardiac function)
Change to 5% dextrose when glucose <12mM

Question 8

Regular Insulin regimen for ketoacidosis? IM vs. IV

Answer 8

IM: 0.1units/kg/hour
IV: 6-8 hourly initial, adjust re: BSLs

Question 9

in ketoacidosis, what insulin do you switch to after acidosis is resolved?

Answer 9

SC insulin
Novorapid/Humalog
Glargine/detemir

Question 10

normal potassium level?

Answer 10

3.5 - 5mM

Question 11

what do you do re: insulin if K+ is below 3.5mM?

Answer 11

hold off on insulin

give 30mM/hour K+ until it’s >3.5

Question 12

if K+ is >5mM in ketoacidosis, what do you do?

Answer 12

don’t give K+, give insulin, check K+ every hour

Question 13

what do you do if K+ is between 3.5-5mM in ketoacidosis?

Answer 13

give 30mM KCl for every litre of fluid you give during rehydration

Question 14

what do you need to make sure in the ketoacidosic patient before commencing K+ replacement?

Answer 14

make sure they’re not anuric

Question 15

other electrolytes that may need replacing in severe ketoacidosis (pH <6.8)?

Answer 15

Bicarb

Phosphate

Question 16

why not give NaCO3 to all ketoacidosis patients?

Answer 16

will go alkalotic too fast

Question 17

what is hyperglycaemic hyperosmolar state?

Answer 17

there is enough insulin to prevent the ketoacidosis but liver is in gluconeogenesis and glycolysis» raised levels

Question 18

5 Features of Hyperglycaemic Hyperosmolar State

Answer 18

severe hyperglycaemia
no ketoacidosis
profound dehydration
depressed sensorium/coma
>330 mOsm/KG

Question 19

how to rehydrate someone in Hyperglycaemic Hyperosmolar State?

Answer 19

2L hypotonic saline (0.45%) over 1-2 hours

then 1L 2-3 hourly

Question 20

what if patient’s osmolarity if <330mOsm?

Answer 20

may not be Hyperglycaemic Hyperosmolar State

looks fora another cause

Question 21

who dies more? ketoacidosis? or Hyperglycaemic Hyperosmolar State?

Answer 21

Hyperglycaemic Hyperosmolar State

mainly age and comorbidities problem

Question 22

Type 2 diabetic usually gets what kind of hyperglycaemic emerg?

Answer 22

hyperosmolar state rather than ketoacidosis

Question 23

how to patients usually present with hyperglycaemic emergencies?

Answer 23

mixed picture of Hyperglycaemic Hyperosmolar State and ketoacidosis

Question 24

how can someone be alert and talking if they have a glucose of 1.8?

Answer 24

may not feel it due to autonomic neuropathy

Question 25

someone with hypoglycaemic who is unconscious, 2 ways

Answer 25

1. IV 50% dextrose
2. IM/SC glucagon 1mg

Recheck glucose 20-30min later

Question 26

if someone is unconscious with hypoglycaemia, when will they wake up once you’ve corrected it?

Answer 26

proportional to the time they’ve been unconscious for

Question 27

what diebetic drugs can cause hypos?

Answer 27

sulfonylureas - glibenclamide

Question 28

what population tends to suffer more hypos with glibenclamide?

Answer 28

elderly with renal impairment

Question 29

someone with diabetes has a ‘sick day’, what to do?

Answer 29

still take their long acting insulin and short acting PRN