diabetic hyperglycaemic emergencies

Question 1

what are the 2 medical emergencies

Answer 1

DKA
hyperosmolar hyperglycaemic state (HHS)

Question 2

which one has a higher mortality than the other

Answer 2

HHS has a higher mortality than DKA.

Question 3

major precipitating factor for both DKA and HHS + others include

Answer 3

infection
others include discontinuation of or inadequate insulin therapy, acute illness such as myocardial infarction and pancreatitis, new onset of diabetes, or stress (e.g. trauma, surgery); and for HHS, these include inadequate insulin or oral antidiabetic therapy, acute illness in a patient with known diabetes, or stress.

Question 4

DKA mainly occurs in pt with this type of DM

Answer 4

T1D

Question 5

Development of DKA occurs within this time frame

Answer 5

develops rapidly (within hours)

Question 6

development of HHS occurs within this time frame

Answer 6

can take days to develop and consequently the dehydration and metabolic disturbances are more severe at presentation

Question 7

HHS typically occurs in this population

Answer 7

elderly

Question 8

HHS is often the initial presentation of

Answer 8

T2D

Question 9

DKA is characterised by these 3

Answer 9

• hyperglycaemia (blood glucose above 11 mmol/L or known diabetes mellitus)
• ketonaemia (capillary or blood ketone above 3 mmol/L or significant ketonuria of 2+ or more)
• acidosis (bicarbonate less than 15 mmol/L and/or venous pH less than 7.3)

Question 10

what value suggests hyperglycaemia

Answer 10

blood glucose above 11 mmol/L

Question 11

common signs and symptoms of DKA

Answer 11

dehydration due to polydipsia and polyuria, weight loss, excessive tiredness, nausea, vomiting, abdominal pain, Kussmaul respiration (rapid and deep respiration) with acetone breath, and reduced consciousness.

Question 12

a patient presents with rapid and deep respiration, aka Kussmaul respiration. this is a sign of

Answer 12

DKA

Question 13

characteristic features of HHS (3)

Answer 13

hypovolaemia, marked hyperglycaemia (blood glucose above 30 mmol/L without significant hyperketonaemia or acidosis), and hyperosmolality (osmolality above 320 mosmol/kg)

Question 14

common signs and symptoms of HHS

Answer 14

dehydration due to polyuria and polydipsia, weakness, weight loss, tachycardia, dry mucous membranes, poor skin turgor, hypotension, acute cognitive impairment, and in severe cases, shock.

Question 15

The treatment of DKA aims to…

Answer 15

restore circulatory volume, correct electrolyte imbalance and hyperglycaemia, clear ketones and suppress ketogenesis, identify and treat any precipitating causes, and prevent complications.

Question 16

The treatment of HHS aims to ….

Answer 16

correct fluid and electrolyte losses, hyperosmolality and hyperglycaemia, identify and treat any underlying or precipitating causes, and prevent complications.

Question 17

which subset of pt who have DKA will require specialist input

Answer 17

elderly, pregnant, aged 18–25 years, have heart or renal failure, or other serious comorbidities

Question 18

the diabetes specialist team should be involved ASAP after pt is admitted into hospital with DKA, ideally within

Answer 18

24h

Question 19

The drug management of DKA involves

Answer 19

• initially give IV fluid replacement
• followed by IV insulin
• pt who normally take LA (detemir, degludec, glargine) insulin should continue their usual doses throughout treatment
• potassium replacement and glucose may be required to prevent subsequent hypokalaemia and hypoglycaemia, depending on their levels

Question 20

initial drug management of DKA

Answer 20

IV fluids

Question 21

initial drug management of HHS

Answer 21

IV fluids

Question 22

management of HHS

Answer 22

• initially give IV fluids
• followed by IV insulin
• For patients with significant ketonaemia or ketonuria, insulin can be started earlier
• Potassium should be replaced or omitted as required.