Diabetic Emergencies Flashcards

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1
Q

Presentation of DKA

A

Abdo pain, N+V, polyuria + polydypsia, reduced consciouness, kussmaul breathing

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2
Q

What is kussmaul breathing?

A

Deep + laboured breathing - respiratory compensation to blow off CO2

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3
Q

Give 3 possible causes of DKA

A

Infection
Poor compliance to insulin
New presentation of DM1

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4
Q

How is DKA diagnosed (3 things, think D, K + A)

A

D: CAP glucose >11 or known diabetes
K: ketones +++ in blood or ++ in urine
A: Acidotic! pH <7.3 or HCO3 <15

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5
Q

What are the principles of management in DKA?

A

Replace fluid + electrolytes

Insulin!

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6
Q

How much saline do you initially give in DKA

SBP >90 and SBP <90

A

If SBP >90: 1L over 1st hour, then 2 L over 2nd hour

If SBP <90: give 500ml stat boluses and reassess BP

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7
Q

What is the dose of insulin in DKA?

How quickly is it delivered?

A

50 units IV ACTRAPID insulin with saline made up to 50ml

Rate: 0.1 units per kg per hour

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8
Q

When would you give potassium in DKA?

A

If serum potassium is <5.5

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9
Q

What is the main difference in HHS and DKA?

A

In HHS there is no ketone production as there is RESIDUAL INSULIN IN DM2 - enough to prevent acidosis but not enough to prevent hyperglycaemia

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10
Q

What are the 3 parameters for diagnosis in HHS?

A

Hypovolaemia
Marked hyperglycaemia (>30mmol/L)
Osmolality >320

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11
Q

What is HHS usually precipitated by?

A

Some sort of illness/ infection/ dehydration

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12
Q

How is HHS managed?

A

Rehydrate with saline! (at a slower rate than for DKA)

Insulin after an hour if glucose is still high: 50 units ACTRAPID, but at half the rate as for DKA

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13
Q

What is hypoglycaemia?

A

Blood glucose <4 (4 IS THE FLOOR!)

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14
Q

Presentation of hypoglycaemia

A

Drowsiness, confusion, numbess + tingling, seizure, coma

Nervousness, hunger

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15
Q

Which 2 diabetes medications can cause hypoglycaemia?

A

Insulin + sulphonylureas (e.g. glicazide)

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16
Q

Other than diabetes, give 3 causes of hypoglycaemia

A

Alcohol
Insulinoma
Addison’s (in an adrenal crisis)

17
Q

What can trigger hypoglycaemia in a diabetic?

A
Increased insulin
Increased activity
Not eating 
Alcohol
Infection
18
Q

How would you manage hypoglycaemia in a conscious patient?

A

10-20g glucose/ glucogel

Followed by: slow-release carbs

19
Q

How would you manage hypoglycaemia if the patient is unconscious (ABCDE, but the treatment)

A

IM glucagon 1mg

Followed by: IV dex (100-200ml of 10% dex)