Diabetic emergencies

Question 1

Biochemical diagnosis of DKA

Answer 1

Ketonaemia >3mmol/L or significant ketouria
Blood Glucose >11.0mmol/L or diabetic
Bicarbonate 7.3

Question 2

What are common preciptants of DKA?

Answer 2

Infection
Drugs
Alcohol
New diabetic

Question 3

Osmotic related symptoms/signs of DKA

Answer 3

Thirst
Polyuria
Dehydration

Question 4

Ketone related symptoms/sign of DKA

Answer 4

Flushed
Vomiting
Abdo pain
Kussmaul’s breathing

Question 5

Biochemical findings in DKA

Answer 5

High glucose 
High potassium 
High creatinine 
High lactate 
High ketones 
High amylase 
Low sodium 
Low bicarb

Question 6

Causes of death in DKA

Answer 6

Hypokalaemia
Aspiration
Cerebral oedema (kids)

Question 7

Management of DKA

Answer 7

Fluid
Potassium chloride (unless anuria suspected)
IV insulin infusion (0.1 units/kg/hour)

Question 8

Typical features of HHS

Answer 8

Diabetic (‘diet alone’ therapy)
Older age
Young non-caucasions
High refined carb intake pre-event

Question 9

Associated risk with HHS

Answer 9

CVE
Sepsis
Glucocorticoids
Thiazides

Question 10

Biochemical findings of HHS

Answer 10

High glucose 
High sodium 
High osmolarity 
Renal impairment 
Less acidotic than DKA

Question 11

Where does lactate originate?

Answer 11

Red cells, skeletal muscle, brain, renal medulla (end product product anaerobic respiration)

Question 12

Does exercise increase or decrease lactate?

Answer 12

Increase

Question 13

What is Type A lactic acidosis associated with?

Answer 13

Associated with tissue hypoxaemia
Infarcted tissue (ischaemic bowel)
Cardiogenic shock
Hypovolaemic shock (sepsis, haemorrhage)

Question 14

What is Type B lactic acidosis associated with?

Answer 14

Liver disease
Leukaemic states
Diabetes
Consider rare inherited metabolic conditions if well + non-diabetic

Question 15

Clinical features of lactic acidosis

Answer 15

Hyperventilation
Confusion
Stupor/coma

Question 16

Biochemical findings of lactic acidosis

Answer 16

Low bicarb 
Raised anion gap 
Glucose often raised 
Abscence of ketonaemia 
Raised phosphate

Question 17

Treatment of lactic acidosis

Answer 17

Treat underlying condition + fluids

Question 18

Symptoms of hypoglycaemia

Answer 18

Shaking 
Anxious 
Hunger
Fatigue 
Sweating 
Dizziness
Increased HR 
Headache

Question 19

Immediate treatment of a hypoglycaemia

Answer 19

15-20g of glucose or simple carb
Recheck after 15 mins
(keep going till back to nrmal)

Question 20

Treatment of severe hypoglycaemia

Answer 20

1mg glucagon