Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > Diabetic emergencies and high glucose states > Flashcards

Diabetic emergencies and high glucose states Flashcards

1
Q

What is DKA?

A

A disordered metabolic state that usually occurs in the context of an absolute or relative insulin deficiency accomapined by an increase in the counter-regulatory hormones such as glucagon, adrenaline, cortisol and GH

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

How does increased lipolysis lead to acidosis?

A

Increased lipolysis, increased free fatty acids at liver

Increased ketogenesis leading to acidosis

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

How does hyperglycaemia lead to ketosis?

A

Osmotic diuresis leads to glycosuria, electrolyte loss and dehydration which leads to increased lactate and decreased renal function

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

What is needed for the biochemical diagnosis of DKA?

A

Ketonaemia > 3mmol/L or significant ketonuria (2+ on urine stick)
Blood glucose > 11.0 mmol/L or known diabetes
Bicarbonate < 15 mmol/L or venous pH < 7.3

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

What are some common precipitants of DKA?

A

Infection
Ilicit drugs and alcohol
Non-adherence with treatement
Newly diagnosed diabetes

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

What are the osmotic related symptoms of DKA?

A

Thirst and polyrua

Dehydration

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

What are the ketone body related symptoms of DKA?

A

Flushed
Vomiting
Abdominal pain and tenderness
Kaussmauls respiration

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

What are the associated conditions of DKA?

A

Underlying sepsis

Gastroenteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the classic biochemistry of DKA at presentation?

A 
Glucose - around 40 mmol/L 
Potassium - raised above 5.5mmol/L 
Creatinine: often raised
Sodium; often raised
Raised lactate
Blood ketones over 5 
Bicarb below 10 in the most severe cases
Amylase raised 
White cell count around 25
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the main causes of mortality in DKA?

A

Hypokalaemia
Aspiration pneumonia
ARDS
Co-morbidities

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

What are the main causes of mortality in children who present with DKA?

A

Cerebral oedema

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

What are the management principles in DKA?

A

Replace losses: fluid (0.9% sodium chloride, glucose falls to 15, switch to dextrose)
Insulin
Potassium
Phosphate and bicarb very rarely replaced
Address risks; NG tube, monitor K+, prescribe prophylactic LMWH, source sepsis (CXR, blood cultures, MSSU +/- viral ttitres)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does a blood ketone measure test?

A

Beta-hydroxybutryate
Meter range 0-8 mmol/L
<0.6 mmol/L normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does urine ketone testing measure?

A

Acetoacetate
Indicated levels of ketones 2-4 hours previously
Ketonuria persists after clinical improvement due to mobilisation of ketones from fat tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should type 1 diabetics be admitted to hospital?

A 
Unable to tolerate oral fluids
Persistent vomiting
Persistent hyperglycaemia
Persistent positive/ increasing levels of ketones
Abdominal pain
Breathlessness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the typical features of HHS?

A

Hypovolaemia
Hyperglycaemia (BG >30mmol/L) without significant acidosis or ketonaemia
Hyperosmolar (osmolality > 320 mosmol/kg)

17
Q

What is the typical biochemistry in HHS?

A 
Median glucose around 60 mmol/L 
Significant renal impairement
Sodium raised
Significant eleation of osmolality (around 400) i.e. significant dehydration 
Less ketonaemic/ acidotic
18
Q

How is osmolality calculated?

A

Osmolality = (2x (Na+K)) + urea + glucose)

19
Q

What is the normal range for osmolality?

A

275 to 295

20
Q

Compare DKA to HHS?

A

DKA in younger patients
Diabetes in type 1, HHS in type 2
DKA caused by insulin deficiency, HHS caused by dieuretics/ steroids/ fizzy drinks
DKA precipitated by insulin omission, HHS precipitated by a new diagnosis or infection
DKA treatment is insulin, HHS treatment is diet/ OHA/ insulin

21
Q

Where does lactate originate from?

A

Red cells, skeletal muscle, brain and renal medulla
End product of anaerobic metabolism of glucose
Clearance requires hepatic uptake and aerboic conversion to pyruvate then glucose

22
Q

What is type A lactic acidosis?

A

Associated with tissue hypoxaemia - infarcted tissue (ischaemic bowel), cardiogenic shock, hypovomaemic shock (sepsis, haemorrhage)

23
Q

What it type B lactic acidosis?

A

May occur in liver disease
May occur in leukaemic states
Associated with diabetes (10% of DKA associated with lactate >5 mmol/L, with metformin in severe illness states or renal failure)
Also consider rare inherited metabolic conditions if well and non-diabetic

24
Q

What are the clinical features of lactic acidosis?

A

Hyperventilation
Mental confusion
Stupor or coma if severe

25
Q

What are the lab findings of lactic acidosis?

A 
Reduced bicarb 
Raised anion gap (Na+ + K+) - (HCO3 + Cl-)
Glucose variable
Absence of ketonaemia
Raised phosphate
26
Q

What can cause a raised anion gap?

A 
Lactic acidosis
DKA
Starvation
Uraemia
Alcohol
Ethylene glycol
Methanol
Salicylate or paraldehyde poisoning
27
Q

What is the normal anion gap?

A

10-18 mmol/L

28
Q

How is lactic acidosis treated?

A

Underlying condition: fluids, antibiotics

Withdraw offending medication

29
Q

How is alchol induced ketoacidosis treated?

A 
Pabrinex
IV fluids - dextrose
Insulin may be required 
IV anti-emetics
Address alcohol dependency
30
Q

What should be assessed in an acute patient who has diabetes?

A 
What type of diabetes
Medication
Insulin regimen
Blood sugar and keton level
Renal function
Evidence of peripheral or autonomic neuropathy
31
Q

What should the glycaemic control be in diabetics pre-operatively?

A

HbA1c at least less than 75 mmol/mol

32
Q

What is the target level for glucose in inpatients?

A

6-10 mmol/L but 4-12 is accepted

33
Q

Who is likely to get HHS?

A

Diabetics
Elderly or young afro-carribean
High refined CHO intake pre-presentation

34
Q

What carries a risk association and complication factor with HHS?

A

Cardiovascular disease (MI/ stroke)
Sepsis
Medication: steroids/ thiazie diuretics

35
Q

How does the treatment of HHS differ fom DKA?

A

More cautious with fluids due to increased risk of fluid overload
Insulin delivered more slowly
Avoid rapid fluctuations in sodium - consider 0.45% saline
Co-morbidities more common
Screen for a vascular event (silent MI), sepsis
LMWH unless CI

36
Q

How are elective surgical procedures carried out in diabetics?

A

Planned
Pre-assessment clinics
Anaesthetic risk: cardiac, autonomic dsfunction, foot risk
Glycaemic control: HbA1c at least <70 mmol/mol
First on surgical list

37
Q

How are diabetics managed in emergency surgery?

A

Increased risk
Recognise anaesthetic risk in those with micro and macrovascular complications
Care with potassium esp. if glucose high
Post-op sepsis risk if poor control

38
Q

What is the anion gap?

A

(Na+ + K+) - (HCO3- + Cl-)

39
Q

What are the clinical findings of lactic acidosis?

A

Hyperventilation
Mental confusion
Stupor or coma if severe

Endocrine (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions