Diabetic Emergencies Flashcards
Name 2 possible diabetic emergencies.
Diabetic Ketoacidosis. Hyperosmolar hyperglycaemic state.
Diabetic ketoacidosis (DKA)is defined by a triad of…
Hyperglycaemia. Hyperketonaemia. Metabolic acidosis.
Give 2 diabetic ketoacidosis criteria.
Blood glucose greater than 11mmol/L. Blood ketones greater than 3mmol/L. Bicarbonate less than 15mmol/L.
Why can diabetic ketoacidosis lead to hyperkalaemia?
Insulin deficiency, there potassium leaks out cells. Eventually renal loss - result in hypokalaemia and arrhythmias.
Name 2 complications of DKA.
Cerebral oedema (reduced conscious level). Adult respiratory distress syndrome (osmotic shift). Pulmonary embolus due to dehydration. Arrhythmias. Co-morbid states.
Give 3 symptoms of DKA.
Polyuria, polydipsia, thirst. Weight. Blurred vision. Vomiting (ketones). Abdominal pain (ketones). Weakness. Leg cramps.
Give 3 signs of DKA.
Kussmaul respiration (deep sighing/breathing). Dehydration. Tachycardia. Hypotensive. Ketotic factor (ketones in breath).
State 2 principles of DKA treatment.
Fluid replacement (intravenous 0.9% saline) - improve dehydration. Insulin replacement. Potassium replacement. Treat infection. Heparin - prevent pulmonary embolus.
What happens to ketogenesis during a hyperosmolar hyperglycaemic state (HHS)?
It suppresses ketogenesis.
State 2 things that characterize hyperosmolar hyperglycaemia.
Hypovolaemia. Hyperglycaemia (greater than 30mmol/L). Hyperosmolarity (osmolality greater than 320mosmol/kg). Dehydration. Blood ketones less than 3mmol/L.
What level of ketones would you expect from a patient with hyperosmolar hyperglycaemia?
Serum ketones less than 3mmol/L.
State 2 complications of a HHS.
Cerebral oedema. Osmotic demyelination syndrome (due to changes in osmolality). Seizures. Arterial thrombosis. Multi-organ failure. Foot ulceration.
State 2 clinical features of a HHS.
Thirst. Polyuria. Blurred vision. Weakness. Dehydration. Tachycardia. Hypotension. Confusion and drowsiness.
Why is hyperglycaemia maintained in a HHS?
Liver makes lots of glucose via gluconeogenesis.
How is a HHS managed?
Fluid replacement therapy - intravenous 0.9% saline. Insulin replacement - fixed rate intravenous insulin infusion - once glucose level stopped falling with fluid.
