Emergencies

Question 1

DKA

Symptoms

Signs

Diagnosis

Managment

Answer 1

Symptoms - abdominal pain, paraesthesia, headache, atlered mental state, polydypsia, polyuria, nausea, vomiting

Signs - Kusmaul’s breathing, ketotic odour, generalised abdominal tenderness, dehydration

Diagnosis -

Cap glucose/ VBG

ABG

Urine dip

FBC, U’s and E’s, Glucose, Blood ketones,

ECG (potassium)

Management -

Rehydration - 10% of BW within 24 hours

Insulin - 0.1 units/kg (Average person 6-7 units/kg) - until pH is 7.3

Treatment Targets:

Ketones - Reduce by 0.5/mmol/L/hour

Bicarb - Increase venous bicarb by 3.0 mmol/L/hour (generally not replaced because delays fall in lactate, raises CO2 partial pressure and may cause cerebral oedema in young people)

Glucose - Reduce cap glucose by 3.0 mmol/L/Hour

Potassium - maintain between 4.0 - 5.5 mmol/L

VTE prophylaxis

Monitoring - Of U’s and E’s every 2 hours.

Question 2

Treatment Targets for DKA?

Ketones, Bicarb, Glucose, Potassium

Answer 2

Ketones - Reduce by 0.5/mmol/L/hour

Bicarb - Increase venous bicarb by 3.0 mmol/L/hour (generally not replaced because delays fall in lactate, raises CO2 partial pressure and may cause cerebral oedema in young people)

Glucose - Reduce cap glucose by 3.0 mmol/L/Hour

Potassium - maintain between 4.0 - 5.5 mmol/L

Question 3

HHS (Hyperosmolar Hyperglycaemic State)

Symptoms

Signs

Diagnosis

Management

Answer 3

Symptoms - Dehyrdation, Altered consciousness, Thrombosis etc.

Signs - Hypovolaemia (more severe than in DKA)

Story - Longer period of dehydration etc. than DKA

Diagnosis - marked hyperglycaemia (30mmol/l or more)/ without significany hyperketonaemia or acidosis

Us and Es, FBC, Urine output,

Features :

fluid loss expected to be between 100 - 220 ml/kg!

osmolality is usually >320 mosmol/kg

Management-

0.9% IV saline to reverse the dehydration and switch to 0.45% saline if the osmality is still not declining (regularly measure osmolality) (sodium may initally rise ) - 25% bw rehydration!

Glucose - Rate of decrease> 5 mmol/L/ Hour. If no longer falls with fluids alone then give 0.05 units/kg Insulin

VTE Prophylaxis

Question 4

Hypoglycaemia

Presentation

Management

Answer 4

Presentation -

Unconscious -

Question 5

Different Classifiactions for Aortic Dissections

Surgery indicated for ascending or descending aortic dissections?

Answer 5

Stanford and deBakey

Surgery is mainly for ascending aortic dissections