Diabetic Emergencies

Question 1

List the main diabetic emergencies

Answer 1

Diabetic ketoacidosis
Hyperglycaemic hyperosmolar syndrome (HHS)
Lactic acidosis
Alcoholic ketoacidosis
Hyperglycaemia

Question 2

What is diabetic ketoacidosis (DKA)?

Answer 2

Metabolic state that occurs in the context of insulin deficiency, resulting in increase of counter-regulatory hormones (glucagon, adrenaline, cortisol)

Question 3

How do excess ketones form as a result of insulin deficiency?

Answer 3

Increased lipolysis causes increased free fatty acid in the liver, producing more ketones

Question 4

How does hyperglycaemia result from insulin deficiency?

Answer 4

Less glucose utilisation by muscle tissues
Increased proteolysis
Increased glycogenolysis

Question 5

Is DKA more common in type 1 or type 2 diabetes?

Answer 5

Type 1 diabetes

Question 6

Outline the biochemical diagnosis of DKA

Answer 6

Ketonaemia greater than 3mmol/L
Glucose greater than 11mmol/L
Bicarbonate less than 15mmol/L or pH less than 7.3

Question 7

What is the most common precipitant of DKA?

Answer 7

Non-compliance with insulin therapy

Question 8

List symptoms of DKA

Answer 8

Thirst
Polyuria
Vomiting
Abdo pain
Breathlessness (Kussmaul)
Acetone breath

Question 9

What is the blood measurement of ketone?

Answer 9

Beta-hydroxybutarate

Question 10

What is the urine measurement of ketone?

Answer 10

Acetoacetate

Question 11

List some electrolytes that can be lost in DKA

Answer 11

Sodium
Potassium
Phosphate
Also N.B. fluid!

Question 12

List the main complications of DKA

Answer 12

Hypokalaemia
ARDS
Cerebral oedema (esp. in kids)
Aspiration

Question 13

Outline main initial treatment of DKA

Answer 13

Fluids
Potassium
Insulin
Address risk (aspiration, thromboembolism, sepsis)

Question 14

Why might ketonuria persist even after clinical improvement of DKA?

Answer 14

Mobilisation of ketone stores from fat

Question 15

List the typical features of hyperglycaemic hyperosmolar syndrome (HHS)

Answer 15

High glucose
Renal impairment
Raised osmolality
Less ketonaemic

Question 16

How do you calculate osmolality? What is normal range?

Answer 16

(2 x [Na + K]) + urea + glucose

Normal = 285-295

Question 17

Glucose 53.8
Urea 28.3
Na+ 145
K+ 5.6
Calculate osmolality

Answer 17

383.3

Question 18

DKA and HHS tend to occur in younger diabetics. True/False?

Answer 18

False

DKA in younger, HHS in older

Question 19

HHS is more commonly associated with type 1 or type 2 diabetes?

Answer 19

Type 2 diabetes

Question 20

How does treatment in HHS differ from DKA?

Answer 20

More slow and cautious; often just diet-related
May not require insulin
Vascular events more likely

Question 21

What is the normal range of lactate?

Answer 21

0.6-1.2 mmol/L

Question 22

What is the normal anion gap?

Answer 22

10-18 mmol/L