Diabetic Emergencies Flashcards
List the main diabetic emergencies
Diabetic ketoacidosis Hyperglycaemic hyperosmolar syndrome (HHS) Lactic acidosis Alcoholic ketoacidosis Hyperglycaemia
What is diabetic ketoacidosis (DKA)?
Metabolic state that occurs in the context of insulin deficiency, resulting in increase of counter-regulatory hormones (glucagon, adrenaline, cortisol, GH)
How do excess ketones form as a result of insulin deficiency?
Increased lipolysis causes increased free fatty acid in the liver, producing more ketones
How does hyperglycaemia result from insulin deficiency?
Less glucose utilisation by muscle tissues
Increased proteolysis
Increased glycogenolysis
Is DKA more common in type 1 or type 2 diabetes?
Type 1 diabetes
Outline the biochemical diagnosis of DKA
Ketonaemia greater than 3mmol/L
Glucose greater than 11mmol/L
Bicarbonate less than 15mmol/L or pH less than 7.3
What is the most common precipitant of DKA? What are the other risk factors?
Non-compliance with insulin therapy
Infection
Illicit drugs and alcohol
Acute surgical problems
MI
List symptoms of DKA
Thirst Polyuria Vomiting Abdo pain Breathlessness (Kussmaul) Acetone breath
What is the blood measurement of ketone?
Beta-hydroxybutarate
What is the urine measurement of ketone?
Acetoacetate
List some electrolytes that can be lost in DKA
Sodium
Potassium
Phosphate
Also N.B. fluid!
List the main complications of DKA
Hypokalaemia
ARDS
Cerebral oedema (esp. in kids)
Aspiration
Outline main initial treatment of DKA
Fluids (1l/hr of saline, change to dextrose when BG<15)
Potassium
Insulin (6U/hr IV)
Address risk (aspiration, thromboembolism, sepsis) - NG tube, prescribe LMWH, CXR, ECG, blood culture)
Why might ketonuria persist even after clinical improvement of DKA?
Mobilisation of ketone stores from fat
List the typical features of hyperglycaemic hyperosmolar syndrome (HHS)
High glucose (BG > 30mmol/l) Hypovolaemia Hyperosmolar (>320mosmol/kg) Less ketonaemic Renal impairment
How do you calculate osmolality? What is normal range?
(2 x [Na + K]) + urea + glucose
Normal = 285-295
Glucose 53.8 Urea 28.3 Na+ 145 K+ 5.6 Calculate osmolality
383.3
DKA and HHS tend to occur in younger diabetics. True/False?
False
DKA in younger, HHS in older
HHS is more commonly associated with type 1 or type 2 diabetes?
Type 2 diabetes
How does treatment in HHS differ from DKA?
More slow and cautious fluid administration; often just diet-related
May not require insulin (3U/hr if required)
Vascular events more likely
What is the normal range of lactate?
0.6-1.2 mmol/L
What is the normal anion gap?
10-18 mmol/L
What blood sugar level is indicative of hypoglycaemia?
<4.0mmol/l
List the clinical features of hypoglycaemia
Shaking Pale and sweaty Anxious DIzziness Hunger Increased HR/ Palpitations Impaired vision Weakness/ fatigue Irritable Seizure Coma
