Diabetic Emergencies

Question 1

What causes DKA?

Answer 1

Hyperglycaemia + acidosis + hyperosmolar

Question 2

Biochemical diagnosis of DKA

Answer 2

Ketonaemia >3 mmol/L
Blood glucose >11 mmol/L (but doesn’t need to be very high)
Bicarbonate <15 mmol/L or venous pH <7.3

Question 3

What are some signs/symptoms due to hyperosmolality? (3)

Answer 3

Thirst, polyuria, dehydration

Question 4

What are some signs/symptoms due to high ketone bodies? (4)

Answer 4

Flushing
Vomiting
Abdominal pain
Breathless + Kussmaul’s breathing

Question 5

What is the glucose levels in DKA?

Answer 5

11-100 but average is 40

Question 6

What happens to potassium, creatinine, lactate and amylase in DKA?

Answer 6

K+ = often raised to above 5.5mmol/L

Creatinine, lactate and amylase are often raised

Question 7

What happens to sodium in DKA?

Answer 7

Often low

Question 8

Major complications of DKA? (4)

Answer 8

Cardiac arrest due to hypokalaemia
Cerebral oedema
Adult respiratory distress syndrome
Aspiration if not fully conscious 
Thromboembolic risk

Question 9

Management of DKA

Answer 9

In HDU
Give: fluids, insulin, potassium
NG tube, monitor K+, LMWH prophylactically

Question 10

What is hyperglycaemic hyperosmolar syndrome?

Answer 10

Hyperglycaemia more than acidosis

Less common than DKA but higher mortality

Question 11

Who gets HHS?

Answer 11

Older, afro-caribbean

Question 12

Risk factors for HHS?

Answer 12

Steroids, thiazide diuretics

Question 13

Biochemistry of HHS

Answer 13

Glucose 50-100 but 30mmol/L average
No ketonaemia
Bicarbonate >15mmol/L

Question 14

Who gets euglycaemic DKA?

Answer 14

History of alcohol

Question 15

What is the target blood glucose level for in-patient diabetics?

Answer 15

6-10 but 4-12 is acceptable