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Diabetes > Diabetic Emergency > Flashcards

Diabetic Emergency Flashcards

1
Q

How long does it take for the brain to return to normal after DKA

A

45 minutes

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2
Q

What is the triad for DKA

A

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)

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3
Q

What is the cause of ketonaemia

A

FA is partially oxidised to ketone bodies

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4
Q

What causes acidosis

A

Acetoacetate and 3-hydroxybutyrate

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5
Q

What causes dehydration

A

Hyperglycaemia leading to osmotic diuresis

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6
Q

What causes hyperkalaemia

A

K+ loss from cells due to insulin deficiency. K+ is subsequently lost from the kidneys - causes whole body potassium depletion

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7
Q

What causes hyperglycaemia

A

Increased production of glucose from the liver and reduced uptake by muscle/fat

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8
Q

What are the complications of DKA

A 
Cerebral oedema
Adult respiratory distress syndrome
Pulmonary embolus
Arrhythmia
Multi-organ failure
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9
Q

What are the symptoms of DKA

A 
Polyuria, polydipsia, thirst
Weight loss
Blurred vision
Vomiting
Abdominal pain
Weakness
Leg cramps
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10
Q

What are the signs of DKA

A

Kussmaul respiration, ketotic fetor, dehyration, tachycardia, hypotension, hypothermia, confusion, drowsiness, coma

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11
Q

What investigations should be done for DKA

A

Capillary blood glucose
Blood ketones or urine ketones
Venous blood gases

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12
Q

What treatments should be done for DKA

A

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

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13
Q

What is HHS

A

State of severe uncontrolled diabetes

Enough insulin to suppress ketogenesis

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14
Q

What is HHS characterized by

A

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)

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15
Q

What are the complications of HHS

A 
Cerebral oedema
Osmotic demylelination syndrome
Seizures
Arterial thrombosis
Venous thrombosis (pulmonary embolism)
Multiorgan failure
Foot ulceration
Co-morbid condition
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16
Q

What are the clinical features of HHS

A 
Thirst, polyuria
Blurred vision
Weakness
Dehydraiton
Tachycardia
Hypotension
Confusion and drowsiness
Coma
17
Q

What are the management steps for HHS

A

Gradual
Fluid replacement with 0.9% IV saline
Insulin replacement lower than DKA at 0.05 units/kg/hour
Venous thromboembolism prophylaxis

18
Q

What are the sick day rules for people with T1DM

A

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)

19
Q

What is the definition of hypoglycaemia

A

In diabetes below 3.5 mmol/L (under 4 mmol/L for hospital in px)

20
Q

What is SEVERE hypoglycaemia

A

Person becomes unable to treat him/herself because of cognitive capacity induced by hypoglycaemia

21
Q

Why does hypoglycaemia occur in diabetes

A

Side effect of treatment to lower blood glucose by increasing insulin levels e.g. insulin and sulphonylureas
Mismatch between insulin levels and insulin requirements

22
Q

Why is hypoglycaemia a problem

A

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

23
Q

What are the symptoms of hypoglycaemia

A

Autonomic: activation fo ANS - sweating/tremor/palpitations
Neuroglycopaenic: confusion/drowsinesss/speech/behaviour/visual disturbance/incoordination/circumoral paraesthesiae
Hunger
Non-specific

24
Q

What is the treatment for mild hypo

A

Check CBG (under 3.5 mmol)
Oral fast acting carbohydrate 15-20g (e.g. dextrose tablets)
Wait 10 minutes and check again

25
Q

What is the treatment for severe hypo if unconscious

A

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)

26
Q

What is treatment for severe hypo if conscious

A

Check CBG
Treat as for mild hypo is possible
Otherwise try glucogel 2 tubes
Otherwise treat as for unconscious

27
Q

What is the recovery treatment for hypo

A

Once glucose above 3.5 mmol, eat 15-20g long-acting/complex carbohydrate
DO NOT omit insulin injection

Diabetes (3 decks)

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