Diabetic Emergencies Flashcards
Define diabetic ketoacidosis
Disordered metabolic state that occurs in the context of absolute/relative insulin deficiency
Where do ketone bodies come from?
Produce of beta oxidation of fats
Acetyl CoA can enter the TCA cycle or be converted into ketone bodies
State the biochemical diagnosis of DKA
Ketonaemia >3
Blood glucose >11 or known diabetes
Bicarbonate <15 or pH <7.3
What can cause death in a patient with DKA?
Hypokalaemia, aspiration, pneumonia, ARDS, co-mobities
Cerebral oedema in children
What are the precipitants of DKA?
Newly diagnosed
Infection
Illicit drug/alcohol use
Poor self management skills
State the signs and symptoms of DKA
Thirst Polyuria Dehydration Vomiting Abdominal pain Kussmaul's respiration - acidosis Breath smells of ketones
How is DKA managed?
Fluids
Glucose <15 - dextrose
Insulin
Potassium
Why is urine ketone level unreliable?
Ketones are mobilised from fat tissue and excreted
What is euglycaemic ketoacidosis?
Normal blood glucose with increased ketones and metabolic acidosis
What drug is euglycaemic ketoacidosis associated with?
SGLT2 inhibitors
What are the signs/symptoms of hyperglycaemic hyperosmolar syndrome?
Hypovolaemia
Hyperglycaemia
Ketones/bicarbonate insignificant
Osmolality >320mmol/kg
What aspect of a patients diet often puts them at risk of HHS?
High refined carb intake
What are the risks associated with HHS?
CVD
Sepsis
Steroids
Thiazides
Describe the biochemistry of HHS
High glucose over 50
Renal impairment - hypernatraemia
Less ketogenic/acidotic
Increased osmolality
How is HHS managed?
Fluids
Insulin
Sodium - may need saline
Why can alcohol cause ketoacidosis?
Ethanol can be broken down to ketone
How is alcoholic/starvation ketoacidosis managed?
IV pabrinex
Fluids
Anti-emetics
May require insulin
Where does lactate come from?
Red cells
Skeletal Muscle
Brain
Renal Medulla
How is lactate removed from the body?
Hepatic uptake, aerobic conversion to pyruvate
What level should lactate be?
0.6-1.2mmmol/l
Describe type a lactic acidosis
Tissue hypoxaemia
- infarcted tissue
- cardio/hypovolaemic shock
Describe type b lactic acidosis
Diabetes
- DKA
- metformin in renal disease
What are the clinical features of lactic acidosis?
Hyperventilation
Mental confusion
Stupor/coma
What will biochemistry of lactic acidosis show?
Reduced bicarbonate
Raised anion gap
Raised phosphate
Variable glucose
How is lactic acidosis treated?
Fluids
Antibiotics
