Diabetic Emergencies

Question 1

when does DKA occur?

Answer 1

in a state of absolute or relative insulin deficiency PLUS an increase in glucose-increasing hormones eg glucagon etc

Question 2

can DKA occur in both diabetic types?

Answer 2

yes

Question 3

what happens in response to absolute or relative deficiency?

Answer 3

stress hormones activated

Question 4

what 4 processes occur as a response to stress hormone activation?

Answer 4

inc lipolysis
dec glucose uilisation
inc proteolysis
inc glycogenolysis

Question 5

what happens when lipolysis is increased?

Answer 5

more free fatty acids go to liver
ketones are made
get an acidosis
lactate is produced

Question 6

do you get an acidosis or alkalosis from ketones?

Answer 6

acidosis

Question 7

what 3 process contribute to hyperglycaemia in DKA?

Answer 7

decreased glucose utilisation
proteolysis
glycogenolysis

Question 8

what are the negative effects glycosuria has on the body?

Answer 8

electrolyte loss
dehydration
decreased renal function

Question 9

what factor other than acidosis produces lactate?

Answer 9

dehydration

Question 10

main cause of hyperosmolar hyperglycaemic state?

Answer 10

hyperglycaemia causing dehydration

Question 11

what level on urinalysis would indicate the ketonuria needed for diagnosis of DKA?

Answer 11

> 2+

Question 12

what level of ketone in the blood is needed to diagnose DKA?

Answer 12

> 3mmol/l

Question 13

what level is blood glucose usually at it in DKA?

Answer 13

> 11mmol/l

Question 14

what should bicarb levels be at in DKA?

Answer 14

<15mmol/l

Question 15

causes of DKA?

Answer 15

infection
drugs/alcohol
non adherence to treatment
newly diagnosed diabetes

Question 16

what symptoms would make you think the DKA is osmotic related?

Answer 16

thirst
polyuria
dehydration

Question 17

what symptoms would make you think the DKA is ketone body related?

Answer 17

flushed
vomiting
abdo pain
tender
kussmaul breathing

Question 18

what glucose level is suggestive of DKA?

Answer 18

around 40mmol/l

Question 19

what potassium level is suggestive of DKA?

Answer 19

> 5.5

Question 20

which of these should be raised/low in DKA? :
creatinine
sodium
lactate
amylase

Answer 20

raised
reduced
raised
raised

Question 21

what blood ketone level is found in DKA?

Answer 21

> 5

Question 22

nromal range for amylase?

Answer 22

0-100

Question 23

risks of DKA?

Answer 23

ARDS
hypokalaemia
sepsis
thromboembolism

Question 24

most common cause of death in kids with DKA?

Answer 24

cerebral oedema

Question 25

how should you treat DKA?

Answer 25

``` manage in HDU replace fluids, insulin, potassium monitor K+ prescribe LMWH prophylaxis check for sepsis ```

Question 26

how could you check for sepsis?

Answer 26

CXR | blood culture

Question 27

what does a urine ketone monitor test?

Answer 27

acetoacetate

Question 28

urine ketone monitors monitor ketone levels at what time?

Answer 28

2-4hrs previously

Question 29

what chemical does blood ketone monitoring measure?

Answer 29

betahydroxybutyrate

Question 30

should the patient be given a ketone meter?

Answer 30

yes

Question 31

what instances other than DKA would you admit someone with T1DM?

Answer 31

``` unable to tolerate oral fluids persistent vomiting hypo alot persistent positive ketones abdo pain breathlessness ```

Question 32

HHS affects what age group?

Answer 32

elderly

Question 33

what do HHS patients tend to have consumed before they present?

Answer 33

high intake of refined carbs

Question 34

risks of HHS?

Answer 34

``` stroke MI sepsis steroids thiazides ```

Question 35

clinical presentation of HHS?

Answer 35

hypovolaemia hyperglycaemia hyperosmolar state

Question 36

how is the hyperglycaemia different in HHS compared to DKA?

Answer 36

no ketonaemia or acidosis

Question 37

do glucose levels tend to be higher in DKA or HHS?

Answer 37

HHS

Question 38

what ion may be raised on biochem in HHS?

Answer 38

sodium

Question 39

is HHS more common in type 1 or 2?

Answer 39

type 2

Question 40

treatment for HHS?

Answer 40

diet | OHA

Question 41

what causes HHS?

Answer 41

new diagnosis of type 2 | infection

Question 42

should you give fluids for HHS?

Answer 42

yes but be careful incase of overload

Question 43

what should you give for HHS to be carful of co-morbidities?

Answer 43

screen for vascular event sepsis give LMWH

Question 44

should you give insulin for HHS?

Answer 44

only if ketonaemia or ketonuria

Question 45

what is lactate's role in the glucose pathway?

Answer 45

end product of anaerobic glycolysis

Question 46

normal range for lactate?

Answer 46

0.6-1.2

Question 47

when is lactate at its lowest?

Answer 47

fasted state

Question 48

main pathology involved in lactic acidosis?

Answer 48

tissue hypoxaemia

Question 49

consequences of type a lactic acidosis?

Answer 49

cardiogenic shock hypovolaemic shock sepsis infarction

Question 50

what diseases can type b lactic acidosis occur in?

Answer 50

leukaemia liver disease diabetes

Question 51

at what level is lactic acidosis a risk?

Answer 51

>5mmol

Question 52

clinical features of lactic acidosis?

Answer 52

hyperventilation mental confusion coma

Question 53

what medication can cause lactic acidosis?

Answer 53

metformin

Question 54

is bicarbonate raised or decreased in lactic acidosis?

Answer 54

decreased

Question 55

normal range of ion gap?

Answer 55

10 to 18mmol

Question 56

what is the ion gap?

Answer 56

[Na + K] - [HCO3+Cl]

Question 57

what is euglycaemic DKA?

Answer 57

DKA in absence of hyperglycaemia