DKA, Hypos + HHS

Question 1

S+S DKA

Answer 1

Collapse, polyuria/ dipsia, abdo pain, hyperventilating (Kussmaul breathing)

Question 2

Investigations for ?DKA

Answer 2

Bloods - hypokalaemic
Blood glucose >11.1 ABG = metabolic acidosis
Ketones ++ (urine + blood) or >3 serum pH <7.3Bicarb <15

Question 3

1st line management for DKA

Answer 3

Fluid replacement with isotonic salineInsulin IV at 0.1 units/kg/hr
Once BM <15 start 5% dextrose
Correct hypokalaemia: 0.9% 1L hr 0.9% + KCL 1L 2hr x2 0.9% + KCL 1L 4hr x2 0.9% + KCL 1L 6hr x2

Question 4

S+S hypoglycaemia collapse

Answer 4

Rapid onset, preceded by confusion, sweating, tachycardic, tremors, seizures

Question 5

Investigations for ?hypoglycaemia

Answer 5

Plasma glucose <3VBG

LFTs, ketones, U+Es

Question 6

Causes of hypoglycaemia

Answer 6

Usually insulin overuse, missed meals (diabetics)

Others: exogenous drugs, pituitary insufficiency, liver failure, Addisons, islet cell tumours, non-pancreas neoplasms

Question 7

Management of hypoglycaemia

Answer 7

If conscious = 10-20g oral glucose + 100ml lucozade If unconscious - IV 20-30g glucose (200-300ml 10% dextrose)
Glucagon IM if IV not possible

Question 8

Presentation of hyperglycaemic hyperosmolar state

Answer 8

Elderly, T2DM
Hypovolaemic, hyperglycaemic (without high ketones), raised serum osmality
Precipitated by dehydration, illness, poor control
Lethargy, N+V, headaches, altered consciousness
Hyperviscosity of blood = strokes, VTE

Question 9

Management of hyperglycaemic hyperosmolar state

Answer 9

Similar to DKA: saline fluid resus - if hypernatraemia, give 0.45% 1L saline 60mins + K+ if needed
Insulin regime if siginificant ketonemia

Question 10

Pathology of HHS

Answer 10

Hyperglycaemia = osmostic diuresis
Increased osmotic pressure - causes water retention
Leads to loss of Na + K

Question 11

Precipitating factors in DKA

Answer 11

Infection 
Ischemia 
Infarction 
Intoxication 
Insulin missed