Diabetic Emergencies Flashcards
DKA
Diabetic Keto Acidosis
What is DKA
A disordered metabolic state due to an insulin deficiency resulting in the switching to ketones to supply ATP for the brain.
Can DKA occur in both type 1 and 2 diabetics?
Yes it occurs in Type I and II
Why is there a decreased renal function in DKA?
Dehydration due to glycosuria (think osmosis)
Why does glycosuria lead to increased urine output and eventually dehydration?
Urine has a high osmolarity due to the presence of glucose, as a result water moves out of the plasma by osmosis.
What should the blood glucose level be in a DKA?
> 11mmol/L
What should the bicarbonate level be in a DKA?
<15mmol/L
What should the ketonaemia level be in DKA?
> 3mmol/L
On a dipstick what should the Ketone level be?
> 2+
What else should be looked for on lab results in a DKA?
Raised lactate
Creatine often raised
What are the causes of death in a DKA?
Hypokalaemia
Aspiration Pneumonia
ARDs
Cerebral oedema
Which cause of death is common only in children?
Cerebral oedema
What are the osmotic symptoms of a DKA?
Thirst
Polyuria
Dehydrated
What are the ketone related symptoms of a DKA?
Flushed
Vomiting
Abdominal pain
Breathlessness
What is the characteristic breathing pattern and its name related to DKA?
Kussmauls breathing
Heavy and fast ex and inhalation
What are some underlying triggers which could trigger a DKA?
Sepsis
Gastroenteritis
What is the management in DKA?
Fluid replacement
- Saline -> Dextrose
Insulin
Pottasium
HHS
Hyperglycaemic Hypersomolar Syndrome
What is HHS?
Hypovolaemia
Glucose > 30mmol/L
Less ketogenic than DKA
Increased Na+
What are the risks with HHS
Increased risk of Heart failure
What are triggers for a HHS?
High glucose
Steroid injections
What s the treatment for a HHS?
Acute- Insulin
Chronic -Oral hypoglycaemic agents
