Diabetic Emergencies Flashcards

1
Q

What is the triad of DKA

A

hyperglycaemia
high anion gap metabolic acidosis
ketonaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some precipitating factors in known diabetes for DKA

A
inadequate insulin treatment 
non-compliance 
infection 
new-onset diabetes 
MI 
stroke 
acute pancreatitis 
trauma 
drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does DKA present

A

Insulin deficiency causes impaired glucose utilisation as well as increased gluconeogenesis and glycogenolysis resulting in hyperglycaemia
Elevated plasma glucose increases the filtered load of glucose in the renal tubules
As the maximal renal tubular reabsorptive capacity is exceeded glucose is excreted in the urine
The osmotic force exerted by unreabsorbed glucose holds water in the tubules, thereby preventing its reabsorption and increased urine output (osmotic diruresis)
This leads to dehydration and loss of electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 3 ketone bodies produced in DKA

A

2 ketoacids and one neutral ketone (acetone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What might a patient in DKA present with

A

polyuria and polydipsia resulting in dehydration
abdominal pain and vomiting
fatigue, weakness and weight loss
confusion, coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the term given to deep sighing respiration secondary to acidosis

A

Kussmaul’s respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the diagnosis of DKA require

A

plasma glucose >11mmol/L
Positive urinary ketones or plasma ketones >3mmol/L
acidosis (pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of acidosis in DKA

A

metabolic acidosis (associated with low bicarbonate levels and a reduction of partial pressure of carbon dioxide due to compensatory hyperventilation with a high anion gap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should be performed in any patient presenting with DAK

A

ECG and septic screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some other causes of a high anion gap metabolic acidosis

A
lactic acidosis (due to tissue hypo perfusion caused by hypovolaemia, cardiac failure or sepsis) 
renal failure and drugs such as aspirin, methanol and ethylene glycol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does the treatment of DKA include

A
Resuscitation (ABCDE) 
insulin 
fluids 
potassium 
Broad spectrum AB if infection is suspected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why should patients remain nil by mouth for at least 6 hours

A

gastroparesis is common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the only indication for delaying insulin in DKA

A

a serum potassium less than 3.3.mmol/L as insulin will worsen the hypokalaemia by driving potassium into the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How much insulin is given in DKA

A

50U of soluble insulin to 50ml 0.9% saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If the patient is not eating and drinking, what should be used in DKA

A

Sliding scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is dextrose given

A

when the blood glucose reaches 15mmol/L

17
Q

What does insulin deficiency lead to in terms of potassium

A

potassium movement out of the cells and into the extracellular fluid

18
Q

Why must potassium be given in DKA

A

treatment with insulin lowers the potassium concentration and may cause severe hypokalaemia as potassium shifts into the cells under the action of insulin

19
Q

What is monitored hourly for the first 15 hours

A

blood glucose
capillary ketones
urine output

20
Q

What is monitored 4 hourly

A

urea and electrolytes

21
Q

How often are capillary ketones monitored

A

2 hourly

22
Q

What is a serious complication in children with DKA

A

cerebral oedema

23
Q

What are some signs of cerebral oedema

A
Headache
recurrent vomiting 
age-inappropriate incontinence 
irritability 
lethargy 
altered levels of consciousness
24
Q

How can we treat cerebral oedema

A

reducing the rate of fluid administration

administer IV mannitol

25
Q

Describe HHS

A

Hyperosmolar hyperglycaemic state - there is little or no ketoacid accumulation
the serum glucose often exceeds 50mmol/L
plasma osmolality may reach 380mosmol/kg
neurological abnormalities are frequently present
insulin levels are insufficient to allow appropriate glucose utilisation but are adequate to prevent lipolysis and subsequent ketogenesis

26
Q

In what population does HHS usually occur

A

elderly patients with type 2 diabetes

27
Q

What are the clinical presentations of HHS

A

insidious onset of polyuria and polydipsia
severe dehydration
neurological symptoms

28
Q

What investigations are required for HHS

A

serum glucose serum sodium

29
Q

what is the treatment for HHS

A

rehydration until rehydrated
potassium is given in each litre of IV fluid
IV insulin at a rate of 203U per hour
Treat underlying cause
thromboprophylaxis with low molecular weight heparin

30
Q

Describe how hypoglycaemia arises in diabetics

A

insulin is supplied exogenously and its release cannot be turned off
The glcoagon and adrenaline response to hypoglycaemia becomes impaired later in the course of diabetics

31
Q

What are some symptoms of sympathetic overactivity

A
sweating 
anxiety 
tremor 
tachycardia 
palpitations 
pallor nausea 
hunger
32
Q

What are some signs of neuroglycopenia

A
dizziness 
headache 
visual disturbances 
focal neurological defect 
difficulty speaking 
inability to concentrate 
abnormal behaviour 
confusion 
drowsiness 
loss of consciousness or seizure
33
Q

What is hypoglycaemic unawareness

A

When the plasma glucose falls without any warning

34
Q

What does diabetic nephropathy do in terms of insulin requirements

A

it decreases them as insulin is partly degraded by the kidney

35
Q

What is the treatment for hypoglycaemia in a patient that is conscious sad cooperative

A

50g of oral glucose

Lucozade, milk or 3 dextrose tablets

36
Q

What is the treatment for hypoglycaemia in a patient with reduced levels of consciousness

A

50ml of 50% glucose IV

If no IV access then 1mg of glucagon IM

37
Q

What should be given in those with a history of excess alcohol intake

A

IV thiamine prior to dextrose to reduce the risk of precipitating Wernicke’s encephalopathy