DIabetic Emergencies Flashcards by Shirley Ross

DKA can occur in both type 1 and 2 diabetes true/false

True

How well did you know this?

Not at all

Perfectly

DKA usually occurs in what context?

absolute or relative insulin deficency accompanied by,

an increase in counter regulatory hormones

How well did you know this?

Not at all

Perfectly

what are the counter-regulatory hormones in DKA?

glucagon

adrenaline

cortisol

grwoth hormone

How well did you know this?

Not at all

Perfectly

what is used for the biochemical diagnosis of DKA?

ketonaemia or significant ketonuria

blood glucose

bicarbonate

How well did you know this?

Not at all

Perfectly

what level of ketonaemia diagnoses DKA?

>3mmol

How well did you know this?

Not at all

Perfectly

what level of ketonuria on standard urine stick diagnoses DKA?

>2+

How well did you know this?

Not at all

Perfectly

what is the median blood glucose level in DKA?

40 mmol/L

How well did you know this?

Not at all

Perfectly

what bicarbonate level diagnoses DKA?

<15mmol/L

How well did you know this?

Not at all

Perfectly

what venous pH diagnoses DKA?

<7.3

How well did you know this?

Not at all

Perfectly

what commonly precipitates DKA?

infection

drugs/alcohol

non-compliance

newly diagnosed

How well did you know this?

Not at all

Perfectly

what are the typical signs and symtoms of DKA?

thirst and polyuria

dehydration

vomiting

abdo pain/tenderness

breathless

How well did you know this?

Not at all

Perfectly

what is potassium usually at presentaation of DKA?

raised above 5.5mmol/L

How well did you know this?

Not at all

Perfectly

what is seen in creatinine and sodium levels at presentation of DKA?

creatinine- often raised

sodium- often reduced

How well did you know this?

Not at all

Perfectly

what is commonly seen with lactate levels in DKA presentation?

raised lactate is very common

How well did you know this?

Not at all

Perfectly

blood ketones are usually what in DKA?

raised to >5

How well did you know this?

Not at all

Perfectly

raised amylase in DKA can sometimes indicate what other pathology?

pancreatitis- though not always true, can be salivary in orgin

How well did you know this?

Not at all

Perfectly

what is the normal range for amylase?

0-100

How well did you know this?

Not at all

Perfectly

what are the most common causes of death in adults as a complication of DKA?

hypokalaemia

aspiration pneumonia

ARDS

How well did you know this?

Not at all

Perfectly

what is the most common casue of death in children as a complication of DKA?

cerebral oedema

How well did you know this?

Not at all

Perfectly

what are the management principles in DKA in hospital?

replaces losses

address risks

How well did you know this?

Not at all

Perfectly

what should be given to correct losses in DKA?

fluids

insulin

potassium

phosphate/ bicarbonate (rarely)

How well did you know this?

Not at all

Perfectly

what is the fluid treamtent in DKA?

initally 0.9% sodium chloride

glucose falls to about 15

switch to dextrose

How well did you know this?

Not at all

Perfectly

how does insulin deficency affect metabolic balance?

switches metabolic balance in catabolic direction

How well did you know this?

Not at all

Perfectly

how does the liver produce gluocose?

gluconeogenisis (from amino acids)

glycogenolysis (from glycogen)

fat in adipose tissue is reduced to what during lipolysis?

triglycerides and fatty acids

blood ketone testing measures what?

beta-hydroxybutyrate

urine ketone testing measures what?

acetoacetate

urine ketone testing indicates ketone levels over what time period?

2-4 hours previous

what warrants hospital admission in T1DM?

unable to tolerate oral fluids persistent vomiting persistent hyperglycaemia abdo pain/breathlessness inc ketone levels

define Hyperglycaemic Hyperosmolar Syndrome

hypovolemia + hyperglycaemia hyperosmosmolar

what blood glucose level indicates hyperglycaemia in HHS?

**\>30mmol/L** without significant acidosis or ketonaemia

what osmolality indicates hyperosmolar in HHS?

osmolality \>320mosmol/kg

what is often the treatment of HHS?

diet alone

what is the median glucose in HHS?

around 60

is glucose higher or lower in HHS than in DKA?

higher

what is normal osmolality?

285- 295

compared to DKA patients are less ketonaemic/acidotic in HHS true/false

true

how is osmolality calculated?

2x (Na +/- K) + Urea + Glucose

what usually precipitates DKA?

insulin omission

what usually precipitates HHS?

infection

what age groups usually suffer DKA and HHS?

DKA- younger HHS- older

what are the differneces in treatmnet of HHS compared to DKA?

**fluids:** more cautiously- risk of fluid overload **insulin:** more slowly as more sensitive

what is prescribed to all with HHS unless contraindicated?

LMWH

where does lactate originate?

red cells skeletal muscle brain renal medulla

lactate is the end product of anaerobic metabolism of what?

glucose

how is lactate cleared from the body?

hepatic uptake and aerobic conversion to pyruvate then glucose

what is the normal lactate range?

0.6- 1.2mmol/L

when may lactate rise?

severe exercise

acidosis is likely when lactate is at what level?

\>5mmol/L

what is type A lactic acidosis associated with?

tissue hypoxaemia

what is associated with type B lactic acidosis?

diabetes may occur in, liver disease leukaemic states

what are the clinical features of lactic acidosis?

hyperventilation mental confusion stupor or coma if severe

what would the lab findings be in lactic acidosis?

reduced bicarbonate raised anion gap raised phosphate absence of ketonaemia

what is the normal ion range?

10-18mmol/L

how do you treat lactic acidosis?

treat underlying condition fluids antibiotics withdraw offending medication

how would you treat alcohol induced ketoacidosis?

**pabrinex**- hgh dose vitamins IV fluids particularly dextrose

what is the target blodd glucose for hospital inpatients?

**6-10 mmol/L** accept range of 4-12 mmol/L

what is the CPR in patient foot care approach?

**C**heck **P**rotect **R**efer