Diabetic Emergencies Flashcards

1
Q

What are the tests that can diagnose diabetes?

A

Positive oral glucose tolerance test - gold standard
Fasting blood glucose
HbA1c
Serum glucose level

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2
Q

Why isn’t the capillary glucose test used for diagnosing diabetes?

A

Because there’s a lag between it and serum glucose

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3
Q

What are the conditions required for a diagnosis of diabetic ketoacidosis?

A

Hyperglycaemia
Acidosis
Ketoacidosis

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4
Q

Which is more specific: blood or urine ketone levels?

A

Blood ketone levels

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5
Q

What are the precipitating factors of diabetic ketoacidosis?

A
1st presentation of type 1 diabetes
Inadequate/inappropriate insulin therapy
- Just not taking insulin not enough > need another injury
Infections
Psychosocial stressors
Myocardial infarction
Pancreatitis
Drugs
Unknown
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6
Q

What are the treatment principles for ketoacidosis?

A
Resuscitation
Rehydration
Correct electrolyte imbalance
Insulin therapy
Search for underlying cause
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7
Q

Why is insulin therapy important in the treatment of ketoacidosis?

A

To switch of ketogenesis

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8
Q

What are the principles of rehydration in the treatment of ketoacidosis?

A

Individualised for each patient
In 1st 4 hours, give 3 L of normal saline
Change to 10% dextrose + insulin when glucose <=12 mM

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9
Q

What are the principles of potassium balance in the treatment of ketoacidosis?

A

Maintain K between 3.5-5 mM
If K <3.5 mM - replace K first
If K >5 mM - don’t give K > monitor every hour
Make sure patient not anuric before starting K replacement

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10
Q

What other electrolytes should be replaced in the treatment of ketoacidosis?

A

Bicarbonate

Phosphate

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11
Q

What happens to the pH when bicarbonate is administered?

A

Transient rise in pH > drop as kidneys excrete infused bicarbonate

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12
Q

What are the principles of insulin in the treatment of ketoacidosis?

A

Continue infusion until acidosis and ketogenesis resolved

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13
Q

When do you stop IV insulin in the treatment of ketoacidosis?

A

Resolve acidosis
Stop ketogenesis
Started eating and drinking

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14
Q

How do you switch to subcutaneous insulin in the treatment of ketoacidosis?

A
Wait to next meal
Dose of short-acting insulin
Wait 30 min
Switch off IV insulin
If already on insulin therapy, administer long-acting insulin when switching off IV insulin
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15
Q

What is pseudohyponatraemia with hyperglycaemia?

A

Na levels higher than what the blood test shows in setting of hyperglycaemia

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16
Q

What was hyperglycaemic hyperosmolar state (HHS) previously known as?

A

Hyperosmolar non-ketotic coma (HONK)

17
Q

What are the diagnostic criteria for HHS?

A
Severe hyperglycaemia
Minimal ketosis/ketoacidosis
Profound dehydration
Depressed sensorium/coma
Effective osmolarity >330 mOsm/kg
18
Q

What is the treatment for HHS?

A
Fluids
Monitor urine output
Insulin
Potassium
Prophylactic heparin
- Treatment dose of low molecular weight heparin
Search for underlying cause
Avoid rapid correction of hyperglycaemia
- Only halve glucose levels in 1st 24 hours
19
Q

Why is heparin administered prophylactically in the treatment of HHS?

A

Hyperosmolarity a risk factor for venous thrombotic events - and sometimes even arterial thrombotic events

20
Q

What usually determines conscious state in terms of hyperglycaemia?

A

Osmolarity, not degree of acidosis

21
Q

What should you do if the patient has a severely depressed conscious state and their osmolarity is not >330 mOsm?

A

Look for another cause

22
Q

How do you treat hypoglycaemia if the patient is conscious and cooperative?

A

Oral fluids containing sugar

23
Q

How do you treat hypoglycaemia if the patient is unconscious or at risk of aspiration?

A

IV 50% dextrose via antecubital vein

IM/SC glucagon 1 mg

24
Q

When can’t intramuscular injections be administerd?

A

If patients are anticoagulated

25
What happens if you burst the vein when administering glucose?
Necrosis to surrounding tissue
26
After the immediate administration of glucose in a hypoglycaemic case, what do you do?
Administer longer acting carbohydrate; eg: sandwich | Recheck glucose 20-30 mins later and administer further treatment if required
27
How do you manage a case of hyperglycaemia?
Does the patient have type 1 or type 2 diabetes? How is the patient feeling - Nausea and vomiting - could indicate development of diabetic ketoacidosis Why is the patient hyperglycaemic? Manage and treat hyperglycaemia - Correction dose of rapid-acting insulin - Recheck glucose every 1-2 hours - Repeat dose if glucose not dropping - If patient has T1D - Check ketones - Start fluids if appropriate
28
How do you avoid a hyperglycaemic emergency?
If have type 1 diabetes, never omit long-acting insulin Education - Sick day management - Monitoring ketones - Supplemental short-acting insulin regimes Need more not less insulin when unwell
29
How do you avoid a hypoglycaemic emergency?
Always carry form of sugar | Appropriate adjustment of glucose lowering therapies
30
What is the ankle brachial index?
Systolic blood pressure at ankle divided by systolic blood pressure at brachial artery = 1 If ankle pressure higher - calcification of arteries - common in diabetics If brachial artery pressure higher - decreased blood flow to feet
31
What is the critical management of an extremely painful, cold foot?
Ensure not critical limb ischaemia | Exclude osteomyelitis
32
Is plain x-ray good at finding osteomyelitis?
Yes, it is, but if it's normal, can't exclude osteomyelitis
33
What is the use of MRI and bone scans in diagnosing osteomyelitis?
Finds bone marrow oedema | Excludes osteomyelitis