Diabetic Emergencies Flashcards
Define diabetic ketoacidosis
Serum glucose over 250
Serum bicarb under 18
Blood pH under 7.3
Elevated serum ketones
Epidemiology of DKA
- Type 1 DM
- Females and children
Etiology of DKA
- New onset Type 1 DM or insulin noncompliance
- Infection
- Excess ETOH
- Stress (medical, trauma, psych)
- Other (Cushing, pancreatitis, preg)
Pathophys of DKA
- Increased ketone production due to lack of insulin (inability to move glucose into cells, increased glucagon)
- Serum ketones causes NV leading to dehydration
- Glycosuria and ketonuria results in diuresis
Onset of DKA?
Occurs within a few hours of precipitating event
What happens to potassium in the setting of DKA?
- Lack of insulin prevents K from being moved into cells
- Hyperglycemia leads to water movement from IC to EC drawing K out of the cell (solvent drag)
- Cell shrinkage causes intracellular K concentration to increase (more favorable for K to leave cell)
- K loss via increased diuresis and vomiting
- Result: transient hyperkalemia despite total body K depletion
Clinical presentation of DKA
- Dehydration
- Fruity odor
- Kussmaul breathing
- NV, diarhea
Labs of DKA
- Serum gluc over 250
- Urine dipstick positive for gluc, ketones
- Serum ketones present
- Low bicarb, PCO2, pH
Treatment of DKA
- Fluid replacement
- K replacement if necessary (prior to insulin)
- Insulin bolus and infusion AFTER K level is obtained
- Treat any underlying infection
Role of bicarb replacement in DKA treatment
Rarely done and only if pH is less than 7
Complications of DKA
- Hypoglycemia
- Hyperkalemia (arrhythmias)
- Hypokalemia (arrhythmias)
- Cerebral edema
- ARDS/pulm edema
Define hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
Elevated blood glucose (often over 1000) and hyperosmolarity W/O acidosis
Who is MC affected by HHNS?
Elderly and Type 2 DM
Etiologies of HHNS?
- Infection (MC)
- Meds noncompliance
- Stress (medical, trauma, psych)
- Meds (steroids, thiazides, antipsychotics)
- Lack of free water intake (or dehydration)
Pathophys of HHNS
- Insulin resistance (rather than insufficiency like DKA) leads to hyperglycemia but its presence prevents lipolysis (preventing ketone production)
- Hyperglycemia causes hyperosmolarity which stimulates diuresis
Onset of HHNS
Days-weeks (slower than DKA)
MC finding of HHNS?
Altered mental status
Treatment of HHNS
- Aggressive fluid replacement
- K replacement
- Insulin infusion w/o bolus
- Treatment of any underlying infection
Complications of HHNS
- Hypoglycemia
- Hypo/hyperkalemia
- Cerebral edema
- ARDS/pulm edema
Define hypoglycemia
Serum glucose under 50 with symptoms that resolve with glucose administration
Treatment of hypoglycemia
- D50 IV or glucagon IM/SC
- Give juice/food if pt is alert and has gag reflex
- D5W infusion if unable to take PO or if persistent hypoglycemia
- Thiamine
