Diabetic Emergencies

Question 1

DKA is more common in T_DM

Answer 1

DKA is more common in T1DM

Question 2

absolute or relative insulin deficiency results in following:

_____glycaemia
_______molar
_____sis

Answer 2

HYPERglycaemia
HYPERSOmolar
ACIDOsis

Question 3

biochemical diagnosis of DKA:

ketonaemia > _mmol/L or significant ketonuria

blood glucose > __ mmol/L or known DM

bicarbonate < __ mmol/L or venous pH < ___

Answer 3

biochemical diagnosis of DKA:

ketonaemia > 3mmol/L or significant ketonuria

blood glucose > 11 mmol/L or known DM

bicarbonate < 15 mmol/L or venous pH < 7.3

Question 4

name the precipitants of DKA

Answer 4

newly diagnosed
infection
illicit drug and alcohol use
poor self management

Question 5

name the 2 osmotic related typical symptoms and signs of DKA

Answer 5

thirst and polyuria

dehydration

Question 6

name the 4 ketone body related typical symptoms and signs of DKA

Answer 6

flushed
vomiting
abdominal pain
breathless - kussmaul’s respiration

Question 7

classical biochemistry of DKA at diagnosis:

glucose -
potassium - 
creatinine - 
sodium - 
lactate - 
blood ketones - 
bicarbonate - 
amylase - 
WBC -

Answer 7

glucose - median of 40mmol/L
potassium - raised
creatinine - raised
sodium - low
lactate - raised
blood ketones - above 5
bicarbonate - <10
amylase - raised
WBC - median 25

Question 8

name the common complication of the brain in DKA

Answer 8

cerebral oedema

Question 9

name the 2 common complications of the respiratory and GI system in DKA

Answer 9

adult respiratory distress. syndrome

enlarged stomach at risk of aspiration pneumonia

Question 10

name the common complication of the heart in DKA

Answer 10

cardiac arrest

Question 11

management of DKA?

Answer 11

replace losses:

fluid
insulin
potassium
phosphate and bicarbonate rarely replaced

prescribe prophylactic LMWH

Question 12

in the event of DKA, what should the patient be given?

Answer 12

a ketone meter

Question 13

HHS biochemical diagnosis:

hypo/hypervolaemia

hypo/hyperglycaemia

no _____aemia

bicarbonate > 15 mmol/L

osmolarity >___ mosmol/kg

Answer 13

HHS biochemical diagnosis:

HYPOvolaemia

hyperglycaemia

no KETONaemia

bicarbonate > 15 mmol/L

osmolarity >320 mosmol/kg

Question 14

HHS often presents in what 2 types of people?

Answer 14

older patients

young afro-carribeans

Question 15

what is normally consumed before HHS attack?

Answer 15

high refined carbohydrate meal

Question 16

there is a higher glucose in DKA/HHS in comparison to DKA/HHS

Answer 16

there is a higher glucose in HHS in comparison to DKA

Question 17

there is significant ______ impairment in HHS

Answer 17

there is significant RENAL impairment in HHS

Question 18

sodium is often _____ in HHS

Answer 18

sodium is often HIGH in HHS

Question 19

patients with HHS/DKA is less ketogenic/acidotic than those with HHS/DKA

Answer 19

patients with HHS is less ketogenic/acidotic than those with DKA

Question 20

raised osmolarity in those with ___

Answer 20

raised osmolarity in those with HHS

Question 21

osmolarity calculation?

Answer 21

2x[Na] + urea + glucose

Question 22

DKA or HSS:

younger

Answer 22

DKA

Question 23

DKA or HSS:

older

Answer 23

HHS

Question 24

DKA or HSS:

T2DM

Answer 24

HHS

Question 25

DKA or HSS:

T1DM

Answer 25

DKA

Question 26

DKA or HSS:

new diagnosis or infection

Answer 26

HHS

Question 27

DKA or HSS:

diuretics and/or steroid and fizzy drinks can cause

Answer 27

HHS

Question 28

DKA or HSS:

10-50% mortality

Answer 28

HHS

Question 29

DKA or HSS:

treatment is diet/OHA/(insulin

Answer 29

HHS

Question 30

DKA or HSS:

treatment is insulin

Answer 30

DKA

Question 31

DKA or HSS:

<2% mortality

Answer 31

DKA

Question 32

DKA or HSS:

insulin omission

Answer 32

DKA

Question 33

DKA or HSS:

insulin deficiency

Answer 33

DKA

Question 34

treatment for alcohol-induced ketones-acidosis

Answer 34

IV Pabrinex
IV fluids
IV anti-emetics
insulin may be required

Question 35

what is very high in both DKA and HHS?

Answer 35

glucose