Diabetic Emergencies Flashcards
Presentation of DKA
Abdo pain, N+V, polyuria + polydypsia, reduced consciouness, kussmaul breathing
What is kussmaul breathing?
Deep + laboured breathing - respiratory compensation to blow off CO2
Give 3 possible causes of DKA
Infection
Poor compliance to insulin
New presentation of DM1
How is DKA diagnosed (3 things, think D, K + A)
D: CAP glucose >11 or known diabetes
K: ketones +++ in blood or ++ in urine
A: Acidotic! pH <7.3 or HCO3 <15
What are the principles of management in DKA?
Replace fluid + electrolytes
Insulin!
How much saline do you initially give in DKA
SBP >90 and SBP <90
If SBP >90: 1L over 1st hour, then 2 L over 2nd hour
If SBP <90: give 500ml stat boluses and reassess BP
What is the dose of insulin in DKA?
How quickly is it delivered?
50 units IV ACTRAPID insulin with saline made up to 50ml
Rate: 0.1 units per kg per hour
When would you give potassium in DKA?
If serum potassium is <5.5
What is the main difference in HHS and DKA?
In HHS there is no ketone production as there is RESIDUAL INSULIN IN DM2 - enough to prevent acidosis but not enough to prevent hyperglycaemia
What are the 3 parameters for diagnosis in HHS?
Hypovolaemia
Marked hyperglycaemia (>30mmol/L)
Osmolality >320
What is HHS usually precipitated by?
Some sort of illness/ infection/ dehydration
How is HHS managed?
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
What is hypoglycaemia?
Blood glucose <4 (4 IS THE FLOOR!)
Presentation of hypoglycaemia
Drowsiness, confusion, numbess + tingling, seizure, coma
Nervousness, hunger
Which 2 diabetes medications can cause hypoglycaemia?
Insulin + sulphonylureas (e.g. glicazide)