Diabetic Emergencies Flashcards
what size catheter average for adult male?
14-16 with 10cc balloons
3 things to remember when catheterizing?
- don’t push if much resistance
- don’t inflate balloon until you get urine return
- look at their facial expressions
KETONE LEVELs in blood usually how much? How much is bad?
1.5 mmol is bad
what is the top 3 causes of ketoacidosis?
- Inappropriate insulin therapy
- new onset DM1
- alcohol abuse
3 kinds of infections that can cause ketoacidosis?
pneumonia
speticaemia
UTI
4 principles of ketoacidosis treatment?
- rehydration
- correct electrolytes (Potassium)
- insulin therapy (after K+ levels are WNL)
- search for underlying cause
what do you use for ketoacidosis rehydration? any changes to the fluids once the glucose decreases?
Normal Saline (according to cardiac function) Change to 5% dextrose when glucose <12mM
Regular Insulin regimen for ketoacidosis? IM vs. IV
IM: 0.1units/kg/hour
IV: 6-8 hourly initial, adjust re: BSLs
in ketoacidosis, what insulin do you switch to after acidosis is resolved?
SC insulin
Novorapid/Humalog
Glargine/detemir
normal potassium level?
3.5 - 5mM
what do you do re: insulin if K+ is below 3.5mM?
hold off on insulin
give 30mM/hour K+ until it’s >3.5
if K+ is >5mM in ketoacidosis, what do you do?
don’t give K+, give insulin, check K+ every hour
what do you do if K+ is between 3.5-5mM in ketoacidosis?
give 30mM KCl for every litre of fluid you give during rehydration
what do you need to make sure in the ketoacidosic patient before commencing K+ replacement?
make sure they’re not anuric
other electrolytes that may need replacing in severe ketoacidosis (pH <6.8)?
Bicarb
Phosphate
why not give NaCO3 to all ketoacidosis patients?
will go alkalotic too fast
what is hyperglycaemic hyperosmolar state?
there is enough insulin to prevent the ketoacidosis but liver is in gluconeogenesis and glycolysis» raised levels
5 Features of Hyperglycaemic Hyperosmolar State
severe hyperglycaemia no ketoacidosis profound dehydration depressed sensorium/coma >330 mOsm/KG
how to rehydrate someone in Hyperglycaemic Hyperosmolar State?
2L hypotonic saline (0.45%) over 1-2 hours
then 1L 2-3 hourly
what if patient’s osmolarity if <330mOsm?
may not be Hyperglycaemic Hyperosmolar State
looks fora another cause
who dies more? ketoacidosis? or Hyperglycaemic Hyperosmolar State?
Hyperglycaemic Hyperosmolar State
mainly age and comorbidities problem
Type 2 diabetic usually gets what kind of hyperglycaemic emerg?
hyperosmolar state rather than ketoacidosis
how to patients usually present with hyperglycaemic emergencies?
mixed picture of Hyperglycaemic Hyperosmolar State and ketoacidosis
how can someone be alert and talking if they have a glucose of 1.8?
may not feel it due to autonomic neuropathy
someone with hypoglycaemic who is unconscious, 2 ways
- IV 50% dextrose
- IM/SC glucagon 1mg
Recheck glucose 20-30min later
if someone is unconscious with hypoglycaemia, when will they wake up once you’ve corrected it?
proportional to the time they’ve been unconscious for
what diebetic drugs can cause hypos?
sulfonylureas - glibenclamide
what population tends to suffer more hypos with glibenclamide?
elderly with renal impairment
someone with diabetes has a ‘sick day’, what to do?
still take their long acting insulin and short acting PRN
