Diabetic Emergencies Flashcards

1
Q

Hyperglycaemic emergencies

A

DKA= diabetic ketoacidosis

HHS= hyperosmolar hyperglycaemic state

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2
Q

DKA is

A

Complex disordered metabolic state due to absolute or relative insulin deficiency

Occur in type 1 mainly

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3
Q

DKA defines by biochemical triad of

A

Hyperglycaemia
Hyperketonaemia
Metabolic acidosis

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4
Q

DKA diagnostician criteria

A

Blood glucose > 11mmol/l or diabetes

Blood ketones > 3 mmol/l or ketonuria >2+

Bicarbonate < 15 mmol/l and /or venous ph <7.3

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5
Q

Other effects of DKA

A

Dehydration and disordered potassium

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6
Q

DKA pathogenisis route

A

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

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7
Q

Potassium in DKA problem

A

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

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8
Q

Severity of DKA

A

DKA is life threatening

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9
Q

Complications of DKA

A

Cerebral oedema
Adult respiratory distress syndrome/ acute lung injury

Pulmonary embolus

Arrhythmia s

Multi organ failure

Co morbid stress

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10
Q

Symptoms of DKA

A

Polyuria,polydipsia, thirst

Weight loss
Blurred vision
Vomiting
Abdominal pain
Weakness
Leg cramps
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11
Q

DKA investigations

A
Kussmaul respiration
Ketotic factir
Dehydration 
Tachycardia
Hypotension
Mild hypothermia 
Confusion, drowsiness, coma
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12
Q

DKA investigations

A

Near patient (bedside tests)

Capillary blood glucose
Blood ketones
Venous blood gases

Diagnostic criteria

Other investigations 
Glucose /U&amp;E/Fbc
ECG 
CXR
blood culture 
MSU
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13
Q

Aims of treatment for DKA

A

Clear ketonaemia and metabolic acidosis

Avoid complications of DKA and it’s management

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14
Q

Principles of treatment for DKA

A

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

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15
Q

HHS occurs in

A

Type 2 diabetes

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16
Q

HHS ketones present??

A

Enough insulin to surprise ketogenisis

17
Q

HHS categorised by

A

Hypogolaemia
Marked hyperglycaemia
Hyperosmolarity

18
Q

HHS causes

A

High glucose
Osmotic diuretics
Volume depletion

Thirst

19
Q

HHS severity

A

Life threatening

20
Q

Complications at HHS

A

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
21
Q

Clinical features of HHS

A
Thirst 
Polyuria
Blurred vision
Weakness
Dehydration
Tachycardia
Hypotension
Confusion and drowsiness
Coma
22
Q

HHSinvestigations

A

Capillary blood glucose
Blood ketones
Urine ketones
Venous blood gases

23
Q

HHS characteristic features

A

Dehydration
Blood glucose >30mmol/l
Blood ketones <3mmol/l or no urine ketones

Osmolality >320mosmol/kg

24
Q

Management of HHS

A

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

25
Sick day rules for type 1 diabetics
Never stop background insulin (even if vomiting) Check capilllary BG frequently Check for ketones Extra short acting insulin Keep drinking fluid
26
Hypoglycaemia is
Low blood glucose In diabetes defined as < 3.5 mmol/L Midsymptomatic- person recognises the hypo and able to treat themselves Severe- defined as an episode in which the person is unable to treat him/herself because of cognitive capacity induced by hypoglycaemia
27
Hypoglycaemia is a side effect of?
Treatment
28
Hypoglycaemia is a problem as
Brain has no energy Can’t use alternative energy stores In diabetes suppressed glucose and ketone production by liver Glucose diverted to fat and muscle
29
Symptoms of hypoglycaemia
Autonomous nervous system Sweating tremor /palpitations Drowsiness Confusion Visual disturbance Hunger Nausea
30
Treatment of mild hypoglycaemia
Check glucose then give sugary treat and check blood glucose in 10 mins
31
Treatment of severe hypoglycaemia
Unconscious or not able to swallow safely Calle for help ABCDE Check cap blood glucose If conscious do same thing you would do for mild
32
Once recovered from hypo what now
Give long lasting complex carbohydrate: 2 biscuits/ slice of bread Don’t omit not insulin injection