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Y2 ENDOCRINOLOGY > Diabetic Emergencies > Flashcards

Diabetic Emergencies Flashcards

1
Q

List the main diabetic emergencies

A 
Diabetic ketoacidosis
Hyperglycaemic hyperosmolar syndrome (HHS)
Lactic acidosis
Alcoholic ketoacidosis
Hyperglycaemia
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2
Q

What is diabetic ketoacidosis (DKA)?

A

Metabolic state that occurs in the context of insulin deficiency, resulting in increase of counter-regulatory hormones (glucagon, adrenaline, cortisol, GH)

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3
Q

How do excess ketones form as a result of insulin deficiency?

A

Increased lipolysis causes increased free fatty acid in the liver, producing more ketones

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4
Q

How does hyperglycaemia result from insulin deficiency?

A

Less glucose utilisation by muscle tissues
Increased proteolysis
Increased glycogenolysis

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5
Q

Is DKA more common in type 1 or type 2 diabetes?

A

Type 1 diabetes

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6
Q

Outline the biochemical diagnosis of DKA

A

Ketonaemia greater than 3mmol/L
Glucose greater than 11mmol/L
Bicarbonate less than 15mmol/L or pH less than 7.3

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7
Q

What is the most common precipitant of DKA? What are the other risk factors?

A

Non-compliance with insulin therapy

Infection
Illicit drugs and alcohol
Acute surgical problems
MI

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8
Q

List symptoms of DKA

A 
Thirst
Polyuria
Vomiting
Abdo pain
Breathlessness (Kussmaul)
Acetone breath
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9
Q

What is the blood measurement of ketone?

A

Beta-hydroxybutarate

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10
Q

What is the urine measurement of ketone?

A

Acetoacetate

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11
Q

List some electrolytes that can be lost in DKA

A

Sodium
Potassium
Phosphate
Also N.B. fluid!

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12
Q

List the main complications of DKA

A

Hypokalaemia
ARDS
Cerebral oedema (esp. in kids)
Aspiration

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13
Q

Outline main initial treatment of DKA

A

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)

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14
Q

Why might ketonuria persist even after clinical improvement of DKA?

A

Mobilisation of ketone stores from fat

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15
Q

List the typical features of hyperglycaemic hyperosmolar syndrome (HHS)

A 
High glucose (BG > 30mmol/l)
Hypovolaemia
Hyperosmolar (>320mosmol/kg)
Less ketonaemic
Renal impairment
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16
Q

How do you calculate osmolality? What is normal range?

A

(2 x [Na + K]) + urea + glucose

Normal = 285-295

17
Q 
Glucose 53.8
Urea 28.3
Na+ 145
K+ 5.6
Calculate osmolality
A

383.3

18
Q

DKA and HHS tend to occur in younger diabetics. True/False?

A

False

DKA in younger, HHS in older

19
Q

HHS is more commonly associated with type 1 or type 2 diabetes?

A

Type 2 diabetes

20
Q

How does treatment in HHS differ from DKA?

A

More slow and cautious fluid administration; often just diet-related
May not require insulin (3U/hr if required)
Vascular events more likely

21
Q

What is the normal range of lactate?

A

0.6-1.2 mmol/L

22
Q

What is the normal anion gap?

A

10-18 mmol/L

23
Q

What blood sugar level is indicative of hypoglycaemia?

A

<4.0mmol/l

24
Q

List the clinical features of hypoglycaemia

A 
Shaking
Pale and sweaty
Anxious
DIzziness
Hunger
Increased HR/ Palpitations
Impaired vision
Weakness/ fatigue
Irritable
Seizure
Coma
25
Q

Outline the management for hypoglycaemia

A

15-20g of glucose or simple carbs (4-5 glucose tabs, gel tube, full fat coke glucagon IM/ IV)
Recheck blood sugar after 15 minutes

26
Q

Patients always experience symptoms in hypoglycaemia. True/ False?

A

False

Patients can have impaired hypoglycaemia awareness

27
Q

Whar lifestyle habits can contribute to hypoglycaemia risk?

A

Vigorous/ prolonged exercise reduces liver glycogen

Alcohol suppresses gluconeogenesis

28
Q

What initial investigations should be carried out in DKA?

A 
Blood glucose
Ketones
U+Es
CRP, WCC, FBC (inflammatory markers)
HbA1c
29
Q

What are the risk factors for HSS?

A

CV event
CCS or thiazide diuretics
Alcohol
Recent high glucose intake

30
Q

What are the clinical signs of lactic acidosis?

A

Hyperventilation
Mental confusion
Stupor
Coma

31
Q

What is the treatment for lactic acidosis?

A

Withdraw offending med

Treat underlying conditions with fluids and antibiotics

32
Q

What are the clinical signs of alcohol ketoacidosis?

A

Recurrent vomiting
Hypotension
Tachypnoea
Normal blood glucose but increased ketones

Y2 ENDOCRINOLOGY (19 decks)

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