DIabetic Emergencies Flashcards
DKA can occur in both type 1 and 2 diabetes true/false
True
DKA usually occurs in what context?
absolute or relative insulin deficency accompanied by,
an increase in counter regulatory hormones
what are the counter-regulatory hormones in DKA?
glucagon
adrenaline
cortisol
grwoth hormone
what is used for the biochemical diagnosis of DKA?
ketonaemia or significant ketonuria
blood glucose
bicarbonate
what level of ketonaemia diagnoses DKA?
>3mmol
what level of ketonuria on standard urine stick diagnoses DKA?
>2+
what is the median blood glucose level in DKA?
40 mmol/L
what bicarbonate level diagnoses DKA?
<15mmol/L
what venous pH diagnoses DKA?
<7.3
what commonly precipitates DKA?
infection
drugs/alcohol
non-compliance
newly diagnosed
what are the typical signs and symtoms of DKA?
thirst and polyuria
dehydration
vomiting
abdo pain/tenderness
breathless
what is potassium usually at presentaation of DKA?
raised above 5.5mmol/L
what is seen in creatinine and sodium levels at presentation of DKA?
creatinine- often raised
sodium- often reduced
what is commonly seen with lactate levels in DKA presentation?
raised lactate is very common
blood ketones are usually what in DKA?
raised to >5
raised amylase in DKA can sometimes indicate what other pathology?
pancreatitis- though not always true, can be salivary in orgin
what is the normal range for amylase?
0-100
what are the most common causes of death in adults as a complication of DKA?
hypokalaemia
aspiration pneumonia
ARDS
what is the most common casue of death in children as a complication of DKA?
cerebral oedema
what are the management principles in DKA in hospital?
replaces losses
address risks
what should be given to correct losses in DKA?
fluids
insulin
potassium
phosphate/ bicarbonate (rarely)
what is the fluid treamtent in DKA?
initally 0.9% sodium chloride
glucose falls to about 15
switch to dextrose
how does insulin deficency affect metabolic balance?
switches metabolic balance in catabolic direction
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?
Check
Protect
Refer
