Diabetic emergencies

Question 1

What are the 4 main diabetic emergencies?

Answer 1

Diabetic ketoacidosis (DKA)
Hyperglycemic Hyperosmolar Syndrome (HHS)
Alcohol ketoacidosis
Diabetes in hospital

Question 2

What causes DKA?

Answer 2

Lack of insulin results in hyperglycemia and lipolysis

Question 3

What causes acidosis in DKA?

Answer 3

Ketones formed during lipolysis
Lactic acid formation
Dehydration decreasing plasma volume

Question 4

What effect does hyperglycemia have in DKA?

Answer 4

Causes dehydration and lactic acid formation

Question 5

How does DKA present?

Answer 5

Osmotic: Thirst and urination
Ketone: Smell on breath, flushing, vomiting, Breathlessness, abdo pain

Question 6

What are the osmotic presentations of DKA?

Answer 6

Thirst

Urination

Question 7

What are the ketone presentations of DKA?

Answer 7

Smell on breath
FLushing
Vomiting
Breathlessness
Abdo pain

Question 8

How do you diagnose DKA?

Answer 8

> 3mmol/l ketone in blood
11mmol/l glucose in blood
<15mmol/l bicarb or venous pH <7.3

Question 9

What biochem features can be seen in DKA?

Answer 9

Very low or high K+
Low Na+
Raised creatinine and lactate
Very high ketones
Very high glucose
Low bicarb of pH

Question 10

What are five risk factors for DKA?

Answer 10

Youth- less able to compensate
Undiagnosed DM- More common in T1
Infection
Alcohol/drug abuse
Poor insulin management

Question 11

What are the four complications of DKA?

Answer 11

Cardiac arrest- Due to electrolyte imbalance
Adult Respiratory Distress Syndrome
Gastric dilation- Leads to reflux
Cerebral oedema

Question 12

How do you manage DKA?

Answer 12

Fluid replacement
Insulin
Measure ketones
Address risks- LMWH for coag, treat sepsis

Question 13

What is Hyperglycemic Hyperosmolar Syndrome?

Answer 13

Relative insulin deficiency leading to hyperglycemia which results in dehydration and hyperosmolarity.

Question 14

What biochem signs are there of HHS?

Answer 14

Hypovolemia
Hyperglycemia (>30mmol/l)
NO KETONES
Bicarb >15mmol/l or venous pH > 7.3
Osmolality > 320 mosmol/l
Raised Na+

Question 15

Give some risk factors for HHS

Answer 15

Elderly
Black
Undiagnosed DM- More common in T2
Lots of refined carbs
CVD
Sepsis
Medication

Question 16

How do you treat HHS?

Answer 16

Fluid and sodium replacement- do slowly

+/- insulin

Question 17

What is alcoholic ketoacidosis?

Answer 17

Similar to DKA but induced by heavy drinking

Question 18

How do you diagnose AKA?

Answer 18

Marked dehydration
>3mmol/l ketones in blood
<15mmol/l bicarb or <7.3 venous pH
Normally low glucose

Question 19

How do you treat AKA?

Answer 19

IV Pabrinex
IV Fluids
IV Antiemetics
\+/- insulin
Address Alcohol Problem

Question 20

Why can managing diabetes in hospital be a problem?

Answer 20

Change in routine

Tend to have insulin taken away and administered by nurses

Question 21

Why things indicate a T1 diabetic should be admitted to hospital?

Answer 21

Inability to tolerate oral fluids
Persistent vomiting
Persistent hyperglycemia
Persistent increased ketone levels
Abdo pain/ breathlessness

Question 22

What are the glucose targets for someone in hospital?

Answer 22

6-10mmol/l

Question 23

What does bicarbonate need to be for it to be DKA?

Answer 23

<15mmol/l

Question 24

Do you get hypo or hypertension in DKA?

Answer 24

Hypotension

Question 25

Why do you get hypotension in DKA?

Answer 25

Because lose water in urine as attempt to get rid of glucose

Question 26

What can you get apparently high K in DKA when it is actually low?

Answer 26

Because it can redistribute into extracellular compartments but returns and drops when rehydrate.