DIABETIC EMERGENCIES Flashcards

1
Q

What are the 3 criteria for a diagnosis of DKA? Include numbers

A
  1. Ketones >3mmol/L
  2. Blood glucose >11mmol/L
  3. HCO3-<15mmol/L/ pH<7.3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name the 9 circumstances in DKA that may lead to admission to ITU in a patient wth DKA?

A
  1. Ketones >6
  2. HC03-<5
  3. pH<7.1
  4. Hypokalaemia
  5. GCS<12
  6. tachy or bradycardia
  7. SBP<90
  8. O2 sats <92
  9. Organ failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are he principles of IV insulin therapy in DKA?

A
  • Start continuous fixed rate IV infusion via an infusion pump. 50 units human soluble Insulin (Actrapid) made up to 50ml with 0.9% NaCl solution. Infuse at a fixed rate of 0.1unit/kg/hr (i.e. 7ml/hr if weight is 70kg).
  • Maximum initial rate of 15 units/hr is recommended.
  • If the patient normally takes a long or intermediate acting insulin (e.g. Levemir, Lantus, Toujeo, Tresiba, insulitard, Humulin I), continue the basal rate at usual dose and time. Avoid hypoglycaemia. Consider increasing the IV 10% glucose rate and reducing the IV 0.9% NaCl rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the principles of potassium management in DKA?

A

Potassium replacement in mmol/l

  • Over 5.5= Nil
  • 3.5-5.5= 40mmol KCL per litre as per fluid protocol except for the first saline (1 hour) bag
  • Below 3.5= 40 mmol KCL per litre (Senior review, as additional K needed. Consider central line insertion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the principles of 0.9% NaCl therapy in DKA?

A

- If SBP <90 mmHg give 500 ml of 0.9% NaCL over 10-15 minutes. If SBP remains below 90mmHg this may be repeated.

If SBP>90 mmHg give: 0.9% NaCl 1L over 1st hr (no KCL)

  1. 9% NaCl 1L with KCl over next 2 hrs (Check K+)
  2. 9% NaCl 1L with KCl over next 2 hrs (Check K+)
  3. 9% NaCl 1L with KCL over next 4 hrs (Check K+) 0.9%

NaCl 1L with KCL over next 4 hrs (Check K+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the principles of glucose therapy in DKA?

A

When glucose falls below 14 mmol/L or in non-hyperglycaemic DKA presenting with CBG <14mmol/L, commence 10% glucose given at 125ml/hr. It is important to continue 0.9% NaCl solution to correct circulatory volume (Infuse 0.9% NaCl in separate cannula)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the minimum expected drops per hour in

  • ketones
  • venous bicarb
  • CBG
A
  • If capillary ketones measurement is not falling by at least 0.5 mmol/l/hr
  • OR venous bicarbonate not rising by at least 3mmol/L/hr
  • OR CBG not falling by at least 3mmmol.L/hr

Increase insulin infusion rate by 1 unit/hr increments hourly until ketones falls at target rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When can DKA be considered over?

A
  1. Ketones <0.6 (ideally <0.3)
  2. Bicarb >18
  3. pH>7.3
  4. anion gap <10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the principles of management of HHS?

A
  • Fluid resuscitation is usually sufficient
  • Aim to replace 50% of estimated losses in first 12 hours and the remaining in the next 12 hours. Please take into account any significant comorbidities. (Aim for NO > 10mmol/l/24 hr drop in Na)
  • use NaCl 0.9% 1L over 1 hour (over 30 min if SBP<90 +safe to do)
  • 1L over 2 hours
  • 1L over 3 hours
  • 1L over 4 hours
  • 1L over 6 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What dose of insulin can be administered and under what circumstances in HHS?

A

Fixed rate insulin infusion (50 units actrapid+ 50ml 0.9%NaCl) at a rate of 0.05 units/kg/hr, should be commenced once the blood glucose is no longer falling with IV fluids alone (after 2nd bag), OR, immediately if there is significant ketonaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the management of a hypo in a patient who is conscious, oriented and able to swallow? How often should CBG monitoring be? How many times can this be repeated?

A

Oral glucose

  • 15-20g of fast acting carbs

Every 15 minutes

4 times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of a patient who is conscious, not oriented and able to swallow?

A
  • 2 tubes of glucogel
  • or
  • 1mg IM glucagon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the management of a severely confused disorinted patient who is unable to swallow?

A
  • 1mg IM glucagon-> when blood glucose has recovered to >4 give 15-20mg of long acting carbs
  • 100ml of 20% IV dextroseover 10-15 minutes in a large vein with a large flush
How well did you know this?
1
Not at all
2
3
4
5
Perfectly