diabetic emergencies Flashcards
what are the main causes of DKA
infection (don’t follow sick day rules). drugs/ alcohol/ poor compliance/ 45% idiopathic
what is DKA
metabolic disorder with an absolute or relative insulin deficiency AND increase of counter regulatory hormones eg glucagon/ adrenaline/ cortisol/ GH
during an insulin deficiency what stress hormone events take place (6)
lipolysis (ketones and acidosis) + proteolysis/ gylcogenolysis (hyperglycaemia, lactic acid, reduced renal function. osmotic diuresis)
what type of diabetics usually get DKA’s
T1DM
what are signs and symptoms of DKA
tachycardia and hypotension/ thirst, polyuria, dehydration/ vomiting, abdo pain, breathless (sweet)/ sepsis , gastroenteritis
what biochemical diagnosis indicates DKA
ketonaemia (>3 moll/l), hyperglycaemia (>11 can be 40-100), bicarbonate/ pH (<15 moll, pH <7.3)
what other biochemical markers can indicate DKA (excluding ketones, glucose, bicarbonate)
loss of electrolytes (K, Na, phosphate), raised creatinine, lactates, amylase
what are severe risks of DKA
hypokalaemia, ARDS, cerebral oedema, aspiration
how to you manage a DKA patient
fluids (0.9% NaCl, dextrose), insulin, potassium, vitals (prophylactic LMWH if needed)
what is used to measure ketone levels
optium ketone meter (beta hydroxyburtarate >0.6 = high), urine ketone testing (Acetoacetate)
what is euglycemic keto-acidosis
ketoacidosis with normal blood glucose
what is hyperglycaemic hyperosmolar syndrome (HONK)
hyperglycaemia without ketoacidosis often causing hypovolaemia seen in T2DM
what biochem diagnosis indicates HONK (5)
hyperglyacemia (>30 - higher than DKA), no/ mild ketoacidosis, bicarbonate/ pH (>15, pH>7.3), osmolarity >320 (high Na + lactate)
what are the symptoms of HONK
dehydration, weakness, leg cramps, visual problems, confusion, elderly, black, high carb intake before presentation
what are associated risks of HONK
CVD, sepsis, meds