Diabetic emergencies Flashcards
What are the 4 main diabetic emergencies?
Diabetic ketoacidosis (DKA)
Hyperglycemic Hyperosmolar Syndrome (HHS)
Alcohol ketoacidosis
Diabetes in hospital
What causes DKA?
Lack of insulin results in hyperglycemia and lipolysis
What causes acidosis in DKA?
Ketones formed during lipolysis
Lactic acid formation
Dehydration decreasing plasma volume
What effect does hyperglycemia have in DKA?
Causes dehydration and lactic acid formation
How does DKA present?
Osmotic: Thirst and urination
Ketone: Smell on breath, flushing, vomiting, Breathlessness, abdo pain
What are the osmotic presentations of DKA?
Thirst
Urination
What are the ketone presentations of DKA?
Smell on breath FLushing Vomiting Breathlessness Abdo pain
How do you diagnose DKA?
> 3mmol/l ketone in blood
11mmol/l glucose in blood
<15mmol/l bicarb or venous pH <7.3
What biochem features can be seen in DKA?
Very low or high K+ Low Na+ Raised creatinine and lactate Very high ketones Very high glucose Low bicarb of pH
What are five risk factors for DKA?
Youth- less able to compensate Undiagnosed DM- More common in T1 Infection Alcohol/drug abuse Poor insulin management
What are the four complications of DKA?
Cardiac arrest- Due to electrolyte imbalance
Adult Respiratory Distress Syndrome
Gastric dilation- Leads to reflux
Cerebral oedema
How do you manage DKA?
Fluid replacement
Insulin
Measure ketones
Address risks- LMWH for coag, treat sepsis
What is Hyperglycemic Hyperosmolar Syndrome?
Relative insulin deficiency leading to hyperglycemia which results in dehydration and hyperosmolarity.
What biochem signs are there of HHS?
Hypovolemia Hyperglycemia (>30mmol/l) NO KETONES Bicarb >15mmol/l or venous pH > 7.3 Osmolality > 320 mosmol/l Raised Na+
Give some risk factors for HHS
Elderly Black Undiagnosed DM- More common in T2 Lots of refined carbs CVD Sepsis Medication
How do you treat HHS?
Fluid and sodium replacement- do slowly
+/- insulin
What is alcoholic ketoacidosis?
Similar to DKA but induced by heavy drinking
How do you diagnose AKA?
Marked dehydration
>3mmol/l ketones in blood
<15mmol/l bicarb or <7.3 venous pH
Normally low glucose
How do you treat AKA?
IV Pabrinex IV Fluids IV Antiemetics \+/- insulin Address Alcohol Problem
Why can managing diabetes in hospital be a problem?
Change in routine
Tend to have insulin taken away and administered by nurses
Why things indicate a T1 diabetic should be admitted to hospital?
Inability to tolerate oral fluids Persistent vomiting Persistent hyperglycemia Persistent increased ketone levels Abdo pain/ breathlessness
What are the glucose targets for someone in hospital?
6-10mmol/l
What does bicarbonate need to be for it to be DKA?
<15mmol/l
Do you get hypo or hypertension in DKA?
Hypotension
Why do you get hypotension in DKA?
Because lose water in urine as attempt to get rid of glucose
What can you get apparently high K in DKA when it is actually low?
Because it can redistribute into extracellular compartments but returns and drops when rehydrate.
