Diabetic Emergencies Flashcards
Hyperglycaemic emergencies
DKA= diabetic ketoacidosis
HHS= hyperosmolar hyperglycaemic state
DKA is
Complex disordered metabolic state due to absolute or relative insulin deficiency
Occur in type 1 mainly
DKA defines by biochemical triad of
Hyperglycaemia
Hyperketonaemia
Metabolic acidosis
DKA diagnostician criteria
Blood glucose > 11mmol/l or diabetes
Blood ketones > 3 mmol/l or ketonuria >2+
Bicarbonate < 15 mmol/l and /or venous ph <7.3
Other effects of DKA
Dehydration and disordered potassium
DKA pathogenisis route
Insulin deficiency > increase production of glucose from liver + less uptake from fat
Increased lipolysis with release of FA
FA partially oxidised to ketone bodies = ketonaemia
Acetoacetate and 3 hydroxybutyrTe
Potassium in DKA problem
Insulin causes K+ to move into cells
Insulin deficient means K+ leaks out of cells = high extra cellular K+= hyperkalaemia
Hyperkalaemia= renal loss K+ loss> whole body depletion
When DKA treated K+ moves into cells
Whole body is K+ deplete
Extracellular K+ falls quickly
Severity of DKA
DKA is life threatening
Complications of DKA
Cerebral oedema
Adult respiratory distress syndrome/ acute lung injury
Pulmonary embolus
Arrhythmia s
Multi organ failure
Co morbid stress
Symptoms of DKA
Polyuria,polydipsia, thirst
Weight loss Blurred vision Vomiting Abdominal pain Weakness Leg cramps
DKA investigations
Kussmaul respiration Ketotic factir Dehydration Tachycardia Hypotension Mild hypothermia Confusion, drowsiness, coma
DKA investigations
Near patient (bedside tests)
Capillary blood glucose
Blood ketones
Venous blood gases
Diagnostic criteria
Other investigations Glucose /U&E/Fbc ECG CXR blood culture MSU
Aims of treatment for DKA
Clear ketonaemia and metabolic acidosis
Avoid complications of DKA and it’s management
Principles of treatment for DKA
Fluid replacement
-intravenous saline 0.9%
Insulin replacement
- fixed rate intravenous insulin infusion
Potassium replacement
- serum K high but total body K low
Identify and treat cause
Venous thromboembolism prophylaxis
HHS occurs in
Type 2 diabetes
HHS ketones present??
Enough insulin to surprise ketogenisis
HHS categorised by
Hypogolaemia
Marked hyperglycaemia
Hyperosmolarity
HHS causes
High glucose
Osmotic diuretics
Volume depletion
Thirst
HHS severity
Life threatening
Complications at HHS
HHS develops over days and metabolic disturbance is more severe than DKA
Cerebral oedema Osmotic demyelination syndrome Seizures Arterial thrombosis,MI,CVA Venous thrombosis Multi organ failure Foot ulceration
Clinical features of HHS
Thirst Polyuria Blurred vision Weakness Dehydration Tachycardia Hypotension Confusion and drowsiness Coma
HHSinvestigations
Capillary blood glucose
Blood ketones
Urine ketones
Venous blood gases
HHS characteristic features
Dehydration
Blood glucose >30mmol/l
Blood ketones <3mmol/l or no urine ketones
Osmolality >320mosmol/kg
Management of HHS
Gradually and safely normalise osmolality of fluid status and glucose
Fluid replacement:
Intravenous 0.9% saline
Insulin replacement
-fixed rate intravenous insulin infusion (lower than DKA 0.05 units/kg/hour)
Identify and treat the cause
Venous thromboembolism prophylaxis
