Diabetic Emergency Flashcards
How long does it take for the brain to return to normal after DKA
45 minutes
What is the triad for DKA
Hyperglycaemia (blood glucose over 11mmol/) or known diabetes
Hyperketonaemia (over 3 mmol/L or ketonuria over 2+)
Metabolic acidosis (bicarbonate less than 15mmol/l and/or venous pH less than 7.3)
What is the cause of ketonaemia
FA is partially oxidised to ketone bodies
What causes acidosis
Acetoacetate and 3-hydroxybutyrate
What causes dehydration
Hyperglycaemia leading to osmotic diuresis
What causes hyperkalaemia
K+ loss from cells due to insulin deficiency. K+ is subsequently lost from the kidneys - causes whole body potassium depletion
What causes hyperglycaemia
Increased production of glucose from the liver and reduced uptake by muscle/fat
What are the complications of DKA
Cerebral oedema Adult respiratory distress syndrome Pulmonary embolus Arrhythmia Multi-organ failure
What are the symptoms of DKA
Polyuria, polydipsia, thirst Weight loss Blurred vision Vomiting Abdominal pain Weakness Leg cramps
What are the signs of DKA
Kussmaul respiration, ketotic fetor, dehyration, tachycardia, hypotension, hypothermia, confusion, drowsiness, coma
What investigations should be done for DKA
Capillary blood glucose
Blood ketones or urine ketones
Venous blood gases
What treatments should be done for DKA
Fluid replacement - IV 0.9% saline
Insulin replacement - fixed rate IV insulin infusion (0.1 units/kg/hour)
K+ replacement as soon as K+ is in normal range
Venous thromboembolism prophylaxis
What is HHS
State of severe uncontrolled diabetes
Enough insulin to suppress ketogenesis
What is HHS characterized by
T2DM
Hypovolaemia
Hyperglycaemia (over 30mmol)
Hyperosmolarity (serum osmolality over 320)
No significant ketonaemia (serum ketones below 3) or acidosis (pH over 7.3, bicarbonate over 15)
What are the complications of HHS
Cerebral oedema Osmotic demylelination syndrome Seizures Arterial thrombosis Venous thrombosis (pulmonary embolism) Multiorgan failure Foot ulceration Co-morbid condition
What are the clinical features of HHS
Thirst, polyuria Blurred vision Weakness Dehydraiton Tachycardia Hypotension Confusion and drowsiness Coma
What are the management steps for HHS
Gradual
Fluid replacement with 0.9% IV saline
Insulin replacement lower than DKA at 0.05 units/kg/hour
Venous thromboembolism prophylaxis
What are the sick day rules for people with T1DM
Never stop background insulin even if vomiting
Check capillary BG frequently
Check for ketones
Extra short acting insulin if CBG>13mmol/l or blood ketone > 1.5 mmol
Bolus for carohydrate
Keep drinking fluid (100 ml/hour)
What is the definition of hypoglycaemia
In diabetes below 3.5 mmol/L (under 4 mmol/L for hospital in px)
What is SEVERE hypoglycaemia
Person becomes unable to treat him/herself because of cognitive capacity induced by hypoglycaemia
Why does hypoglycaemia occur in diabetes
Side effect of treatment to lower blood glucose by increasing insulin levels e.g. insulin and sulphonylureas
Mismatch between insulin levels and insulin requirements
Why is hypoglycaemia a problem
Brain has no energy stores and can’t use alternate energy sources
Excess insulin causes suppressed glucose and ketone production in the liver
Glucose diverted to muscle and fat
What are the symptoms of hypoglycaemia
Autonomic: activation fo ANS - sweating/tremor/palpitations
Neuroglycopaenic: confusion/drowsinesss/speech/behaviour/visual disturbance/incoordination/circumoral paraesthesiae
Hunger
Non-specific
What is the treatment for mild hypo
Check CBG (under 3.5 mmol)
Oral fast acting carbohydrate 15-20g (e.g. dextrose tablets)
Wait 10 minutes and check again
What is the treatment for severe hypo if unconscious
Unconscious:
Call for help, ABCDE, check CBG, IV glucose (20% 75-100ml) or glucagon 1 mg sc/im. Wait 10 minutes and repeat (not glucagon)
What is treatment for severe hypo if conscious
Check CBG
Treat as for mild hypo is possible
Otherwise try glucogel 2 tubes
Otherwise treat as for unconscious
What is the recovery treatment for hypo
Once glucose above 3.5 mmol, eat 15-20g long-acting/complex carbohydrate
DO NOT omit insulin injection
