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03- Endocrine > DIabetic Emergencies > Flashcards

DIabetic Emergencies Flashcards

1
Q

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

A

True

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2
Q

DKA usually occurs in what context?

A

absolute or relative insulin deficency accompanied by,

an increase in counter regulatory hormones

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3
Q

what are the counter-regulatory hormones in DKA?

A

glucagon

adrenaline

cortisol

grwoth hormone

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4
Q

what is used for the biochemical diagnosis of DKA?

A

ketonaemia or significant ketonuria

blood glucose

bicarbonate

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5
Q

what level of ketonaemia diagnoses DKA?

A

>3mmol

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6
Q

what level of ketonuria on standard urine stick diagnoses DKA?

A

>2+

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7
Q

what is the median blood glucose level in DKA?

A

40 mmol/L

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8
Q

what bicarbonate level diagnoses DKA?

A

<15mmol/L

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9
Q

what venous pH diagnoses DKA?

A

<7.3

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10
Q

what commonly precipitates DKA?

A

infection

drugs/alcohol

non-compliance

newly diagnosed

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11
Q

what are the typical signs and symtoms of DKA?

A

thirst and polyuria

dehydration

vomiting

abdo pain/tenderness

breathless

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12
Q

what is potassium usually at presentaation of DKA?

A

raised above 5.5mmol/L

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13
Q

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

A

creatinine- often raised

sodium- often reduced

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14
Q

what is commonly seen with lactate levels in DKA presentation?

A

raised lactate is very common

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15
Q

blood ketones are usually what in DKA?

A

raised to >5

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16
Q

raised amylase in DKA can sometimes indicate what other pathology?

A

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

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17
Q

what is the normal range for amylase?

A

0-100

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18
Q

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

A

hypokalaemia

aspiration pneumonia

ARDS

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19
Q

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

A

cerebral oedema

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20
Q

what are the management principles in DKA in hospital?

A

replaces losses

address risks

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21
Q

what should be given to correct losses in DKA?

A

fluids

insulin

potassium

phosphate/ bicarbonate (rarely)

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22
Q

what is the fluid treamtent in DKA?

A

initally 0.9% sodium chloride

glucose falls to about 15

switch to dextrose

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23
Q

how does insulin deficency affect metabolic balance?

A

switches metabolic balance in catabolic direction

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24
Q

how does the liver produce gluocose?

A

gluconeogenisis (from amino acids)

glycogenolysis (from glycogen)

25
Q

fat in adipose tissue is reduced to what during lipolysis?

A

triglycerides and fatty acids

26
Q

blood ketone testing measures what?

A

beta-hydroxybutyrate

27
Q

urine ketone testing measures what?

A

acetoacetate

28
Q

urine ketone testing indicates ketone levels over what time period?

A

2-4 hours previous

29
Q

what warrants hospital admission in T1DM?

A

unable to tolerate oral fluids

persistent vomiting

persistent hyperglycaemia

abdo pain/breathlessness

inc ketone levels

30
Q

define Hyperglycaemic Hyperosmolar Syndrome

A

hypovolemia

+

hyperglycaemia

hyperosmosmolar

31
Q

what blood glucose level indicates hyperglycaemia in HHS?

A

>30mmol/L

without significant acidosis or ketonaemia

32
Q

what osmolality indicates hyperosmolar in HHS?

A

osmolality >320mosmol/kg

33
Q

what is often the treatment of HHS?

A

diet alone

34
Q

what is the median glucose in HHS?

A

around 60

35
Q

is glucose higher or lower in HHS than in DKA?

A

higher

36
Q

what is normal osmolality?

A

285- 295

37
Q

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

A

true

38
Q

how is osmolality calculated?

A

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

39
Q

what usually precipitates DKA?

A

insulin omission

40
Q

what usually precipitates HHS?

A

infection

41
Q

what age groups usually suffer DKA and HHS?

A

DKA- younger

HHS- older

42
Q

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

A

fluids: more cautiously- risk of fluid overload

insulin: more slowly as more sensitive

43
Q

what is prescribed to all with HHS unless contraindicated?

A

LMWH

44
Q

where does lactate originate?

A

red cells

skeletal muscle

brain

renal medulla

45
Q

lactate is the end product of anaerobic metabolism of what?

A

glucose

46
Q

how is lactate cleared from the body?

A

hepatic uptake and aerobic conversion to pyruvate then glucose

47
Q

what is the normal lactate range?

A

0.6- 1.2mmol/L

48
Q

when may lactate rise?

A

severe exercise

49
Q

acidosis is likely when lactate is at what level?

A

>5mmol/L

50
Q

what is type A lactic acidosis associated with?

A

tissue hypoxaemia

51
Q

what is associated with type B lactic acidosis?

A

diabetes

may occur in, liver disease

leukaemic states

52
Q

what are the clinical features of lactic acidosis?

A

hyperventilation

mental confusion

stupor or coma if severe

53
Q

what would the lab findings be in lactic acidosis?

A

reduced bicarbonate

raised anion gap

raised phosphate

absence of ketonaemia

54
Q

what is the normal ion range?

A

10-18mmol/L

55
Q

how do you treat lactic acidosis?

A

treat underlying condition fluids

antibiotics

withdraw offending medication

56
Q

how would you treat alcohol induced ketoacidosis?

A

pabrinex- hgh dose vitamins

IV fluids particularly dextrose

57
Q

what is the target blodd glucose for hospital inpatients?

A

6-10 mmol/L

accept range of 4-12 mmol/L

58
Q

what is the CPR in patient foot care approach?

A

Check

Protect

Refer

59
Q
A

03- Endocrine (9 decks)

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