Endo- diabetic emergencies Flashcards
what is hypoglycaemia
abnormally low blood glucose level, typically under 4mmol/l
what is the most common side effect of insulin therapy
hypoglycaemia
precipitating factors to hypoglycaemia episodes
irregular eating habits
alcohol excess
unusal exertion
more insulin injected than needed
times of greatest risk of hypoglycaemia
before meals
during the night
during or after exercise
mild hypo management
consumption of 15-20g fast acting carbohydrate such as glucose tablets, small can of non-diet soda, sweets, or fruit juice
is chocolate useful for hypo management
no- slower absorption
what should you consume after a hypo
slow acting carbs eg toast
severe hypo management
200ml 10% dextrose IV
- if no IV access, 1mg glucagon IM
increased insulin demand (5 Is)
infection- UTIs, pneumonia, cellulitis
inflammation- pancreatitis, cholecystitis
intoxication- alcohol, cocaine, methanol
infarction- acute MI, stroke
iatrogenic- surgery, steroids
what can excessive accumulation of ketone bodies lead to
acidosis
osmotic related clinical features of diabetic ketoacidosis
thirst and polyuria
dehydration
ketone body related clinical features of diabetic ketoacidosis
flushed
vomiting
abdominal pain and tenderness
> respiratory rate
distinctive smell on breath (sweet and fruity)
diabetic ketoacidosis associated conditions
sepsis
gastroenteritis
complication of diabetic ketoacidosis which mostly happens in children/YAs
cerebral oedema
initial management in diabetic ketoacidosis
replace fluid losses- sodium chloride
and potassium
insulin replacement
diabetic ketoacidosis insulin replacement rate
0.1units/kg per hour
clinical features of hypoglycaemia
pallor
sweating
palpitations
nausea
hunger
cognitive impairment
tremor
confusion
characteristic triad of Hyperglycaemic hyperosmolar syndrome
severe Hyperglycaemia (>33.3 mmol/l)
hyperosmolality (>320mmol/kg)
volume depletion in absence of ketoacidosis (pH >7.3 and bicarbonate >15mmol/l)
where does the formation of ketone bodies occur
liver mitochondria from acetyl-coA
diagnostic criteria of diabetic ketoacidosis
ketonaemia >/=3mmol/l
blood glucose >11.1mmol/l
bicarbonate <15mmol/l
pH <7.3
potassium and sodium raised/low in diabetic ketoacidosis
potassium >5.5mmol/l
sodium often low/low end of normal
