EM- metabolic emergencies Flashcards
what is “ketosis”?
Ketosis is a metabolic process that occurs when the body begins to burn fat for energy because it does not have enough carbohydrates to burn. During this process, the liver produces chemicals called ketones
3 causes of hypoglycemia? ketosis
fasting
malabsorption, GE
increased utilization: exertion
3 causes of hypoglycemia? non-ketosis
hyperinsulinism
adrenal insufficiency
congenital disorders
*also drugs, sepsis, hepatic failure
hypoglycemia: S+S, PE
S+S: AMS; anxiety, shakiness, nausea, sweating
PE: confusion, diaphoresis, tremor
tachycardia, incr BP
obtundation, seizures
what labs dx hypoglycemia?
glucose <50 mg/dL
txt for hypoglycemia?
orange juice, snickers
IV D50: 1amp then 100 cal/hr for 2 hrs
what is the pathophys if DKA?
liver has increased glucose production but peripheral tissues have decr. glucose uptake = hyperglycemia
–> osmotic diuresis and vol. depletion
liver rapidly increases ketogenesis (body NEEDs fuel) and Adipose releases free fatty acids = ketoacidosis
–> decreased alkali reserve and metabolic acidosis
symptoms of DKA
Polydipsia, polyuria, weakness, nausea/vomiting, abdominal pain, weight loss
PE findings for DKA: temp, HR, GI etc.
Hypothermia (hyper if infectious etio), tachycardia, tachypnea/hyperpnea (Kussmaul resps), ileus, maybe altered MS. acetone breath (fruity)
4 Dx labs for DKA
Glucose >250 mg/dL
+ serum acetone
pH≤ 7.3
Anion gap >12
what things can cause DKA?
increased cortisol
insulin omission (can’t use glucose)
inflammation; infection ; ischemia
what things 5 can cause DKA?
increased cortisol
insulin omission (can’t use glucose)
inflammation; infection ; ischemia
4 goals of DKA mgmt?
- Volume resuscitate!!! 2L NaCl (for hypoperfused organs)
- Correct AG acidosis
- Target glucose: 150-200 mg/dL
- Correct K+ and Mg2+
if you give insulin to drive glucose into the cells, what electrolyte imbalance can you cause?
hypokalemia? so supplement with K+ if they might already be low in K+
(rather be high in K+ than low)
how do you give fluids for DKA? (kinda weeds?)
- 2L normal Saline for the 1st hour
- Replace 50% of estimated TBW deficit over 8 hours
CHANGE to D5 ½ NS @ 150 mL/hr when glucose <250 mg/dL
DKA: If K _____ mEq/L, hold insulin until actively correcting K. what is your K+ goal?
< 3.3 mEq/L
Goal K+ = 4 - 5 mEq/L
how often do you check glucose when resuscitating for DKA?
finger stick every hour
*Initial Goal: decr. Glucose by 50 - 75/hour
If glucose not decreasing by ≥ 50 mg/dL in 1st hour - double IV insulin rate
do you give bicarb supplement for DKA?
only if pH <7
what is the normal level of K+? what level is life threatening?
normal: 3.5- 5
life threatening: >7.5
ekg findings of hyperkalemia?
peak T waves = hyperkalemia
BUT even if they have a normal EKG, if they have high K+ - still need to treat them
what are the 3 mechanisms to hyperkalemia?
- Excessive cellular release: rhabdo, burns, tumor lysis syndrome, crush injury, if theyve had a tourniquette on a long time
- Excessive intake: KCL supplements
- Insufficient excretion: AKI, CKD
4 clinical causes of hyperkalemia?
- renal insufficiency : DIALYSIS!!!
- Meds (interferes w/excretion): ACEIs, ARBs, spironolactone, NSAIDs,
- Mineralocorticoid deficiency: e.g. Addison’s
- DKA (but you only wanna txt this with insulin)
what is the most common cause of a hyperkalemia finding in lab results?
hemolysis from poor labs. Redo the lab sample if K+ >7 but no S+S
K+ >7 causes what? what about >9?
> 7: conduction abnormalities and bradycardia
>9: Cardiac arrest due to… asystole, Vfib, PEA w/ bizarre wide complex rhythm
