Diabetic Emergencies

Question 1

what is DKA

Answer 1

diabetic ketoacidosis is a disordered metabolic state due to insulin deficiency

Question 2

what is activated in DKA

Answer 2

stress hormone activation which causes lipolysis, proteolysis and glycogenolysis

Question 3

outcomes of insulin deficiency

Answer 3

DKA = hyperglycaemia and dehydration with ketones and acidosis

Question 4

presentation of DKA

Answer 4

osmotic symptoms

ketones= flushing, vomiting, abdominal pain, Kussmaul’s respiration, pear drop smell on breath

Question 5

diagnosis of DKA

Answer 5

ketonuria
pear-drop smell on breath (ketones)
high blood glucose >11mmol/L
acidosis (bicarbonate <15mmol/L or pH <7.3)

Question 6

management of DKA

Answer 6

fluids
insulin
K+

Question 7

what is hyperglycaemia hyperosmolar syndrome (HHS)?

Answer 7

state due to relative insulin deficiency

Question 8

what is often the history preceding HHS?

Answer 8

high refined CHO intake pre-presentation

Question 9

diagnosis of HHS

Answer 9

hypovolaemia
high glucose >50mmol/L (more than DKA)
low ketones <3mmol/L
alkalosis (bicarbonate >15/ pH >7.3)

Question 10

management of HHS

Answer 10

fluids (beware of overload)
LMWHs
insulin if required

Question 11

presentation of alcohol-induced keto-acidosis

Answer 11

dehydration
ketones
acidosis
NORMAL glucose

Question 12

management of alcohol- induced keto-acidosis

Answer 12

vitamins
fluids
anti-emetics

Question 13

what is the end product of anaerobic metabolism?

Answer 13

lactate

Question 14

what is lactic acidosis?

Answer 14

build-up of lactate so much that it causes acidosis