Diabetic emergencies Flashcards
What is DKA?
A lack of insulin leading to increased ketone production to induce an acidotic state
What are the features of a DKA? (4)
Abdominal pain
Fluid loss: thirst/lots of pee, dehydration
Deep hyperventilation (Kussmaul breathing)
Sickly sweet breath
JBAS criteria for DKA (4)
Glucose: >11mmol/l or diabetic
pH: 7.3 (acidosis)
HCO3: <15mmol (metabolic cause)
Ketones: >3mmol or raised ketones on urinalysis
What are the 3 goals of management of DKA?
Fluids: 0.9%NaCl w KCL 1000ml (1hr, 2hr, 2hr, 4hr,4hr,6hr)
Insulin: IV 0.1 unit/kg/hr until glucose <15mmol/l then 5% dextrose
Electrolytes: Correct hypokalaemia
What are the complications of DKA and its treatment (list 3)
Gastric stasis thromboembolism arrhythmias (electrolytes/iatro) Fluid/electrolyte imbalances ARDS kidney damage
What is HHS?
hyperosmolar hyerglycaemic state
How does HHS come about?
A stressor (eg. infection) leads to lower insulin production Dehydration: More glucose .'. water pissed out Acidosis: dehydration and increased ketogenesis leads to reduced pH
What are 5 biochemical signs of HHS? (blood volume, glucose, ketones, HCO3, osmolarity)
Volume: Low Glucose: high Ketones: not/mildly raised (<3mmol) Bicarbonate: High osmolarity: >320mmol/kg
typical HHS patient?
Older mostly T2DM Afro-caribbean steroids/diuretics Co-morbidities
diagnosis of HHS
Hypovolaemia
Hyperglycemia
no significant ketonaemia
Treatment of HHS?
Fluids
electrolytes
fix blood glucose (insulin)
Prevent CV complications
What is Alcohol related ketoacidosis
Alcoholics dont eat/vomit what theyve eaten
starvation leads to excess B oxidation
Ketoacidosis results
what does this inidicate: Hypovolaemia ketonaemia (>3mmol) HCO3: low glucose: low
ARKA vomiting causes hypovolaemia ketonaemia due to lack of food HCO3 low as its a metabolic acidosis Low glucose: alcohol suppresses gluconeogenesis
