diabetic emergencies Flashcards

1
Q

what are the main causes of DKA

A

infection (don’t follow sick day rules). drugs/ alcohol/ poor compliance/ 45% idiopathic

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2
Q

what is DKA

A

metabolic disorder with an absolute or relative insulin deficiency AND increase of counter regulatory hormones eg glucagon/ adrenaline/ cortisol/ GH

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3
Q

during an insulin deficiency what stress hormone events take place (6)

A

lipolysis (ketones and acidosis) + proteolysis/ gylcogenolysis (hyperglycaemia, lactic acid, reduced renal function. osmotic diuresis)

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4
Q

what type of diabetics usually get DKA’s

A

T1DM

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5
Q

what are signs and symptoms of DKA

A

tachycardia and hypotension/ thirst, polyuria, dehydration/ vomiting, abdo pain, breathless (sweet)/ sepsis , gastroenteritis

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6
Q

what biochemical diagnosis indicates DKA

A

ketonaemia (>3 moll/l), hyperglycaemia (>11 can be 40-100), bicarbonate/ pH (<15 moll, pH <7.3)

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7
Q

what other biochemical markers can indicate DKA (excluding ketones, glucose, bicarbonate)

A

loss of electrolytes (K, Na, phosphate), raised creatinine, lactates, amylase

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8
Q

what are severe risks of DKA

A

hypokalaemia, ARDS, cerebral oedema, aspiration

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9
Q

how to you manage a DKA patient

A

fluids (0.9% NaCl, dextrose), insulin, potassium, vitals (prophylactic LMWH if needed)

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10
Q

what is used to measure ketone levels

A

optium ketone meter (beta hydroxyburtarate >0.6 = high), urine ketone testing (Acetoacetate)

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11
Q

what is euglycemic keto-acidosis

A

ketoacidosis with normal blood glucose

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12
Q

what is hyperglycaemic hyperosmolar syndrome (HONK)

A

hyperglycaemia without ketoacidosis often causing hypovolaemia seen in T2DM

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13
Q

what biochem diagnosis indicates HONK (5)

A

hyperglyacemia (>30 - higher than DKA), no/ mild ketoacidosis, bicarbonate/ pH (>15, pH>7.3), osmolarity >320 (high Na + lactate)

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14
Q

what are the symptoms of HONK

A

dehydration, weakness, leg cramps, visual problems, confusion, elderly, black, high carb intake before presentation

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15
Q

what are associated risks of HONK

A

CVD, sepsis, meds

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16
Q

what treatment is given for HONK

A

fluids, insulin (if needed), watch morbidities

17
Q

what symptoms + biochem are seen in alcoholic/ starvation ketoacidosis

A

HISTORY, dehydration, ketonemia, low bicarb/ pH, glucose normal/ low

18
Q

how does ethanol cause ketoacidosis

A

ethanol –> acid

19
Q

how do you manage alcoholic/ starvation ketoacidosis

A

IV vitamins/ fluids/ anti-emetics (insulin if needed)