Exam 3 Week 2 Flashcards
What is Diabetic Keto Acidosis?
A metabolic disorder that occurs suddenly, most often seen in type 1 diabetes and younger (newly diagnosed patients). It is caused by an absence or inadequate amount of insulin.
What are the three main clinical features of Diabetic Keto Acidosis?
- Hyperglycemia
- Dehydration and electrolyte loss
- Acidosis and ketones
What happens to glucose without insulin?
Glucose is unable to enter the cells, leading to increased gluconeogenesis, which causes hyperglycemia.
What is the effect of insulin deficiency on the kidneys?
The kidneys will excrete glucose along with electrolytes and water, leading to water and electrolyte loss.
What is lipolysis?
The breakdown of fat into free fatty acids and glycerol, which leads to the production of ketone bodies (which is an acid) the accumulation of ketones leads to metabolic acidosis.
What are long-term complications of Diabetic Keto Acidosis?
Microvascular / Macrovascular complications, and neuropathies.
What are the causes of Diabetic Keto Acidosis?
- Decreased or missed insulin
- Illness or infection
- Undiagnosed and untreated diabetes
What are some clinical manifestations of Diabetic Keto Acidosis?
Polyuria, polydipsia, marked fatigue, blurred vision, weakness, headache, frank hypotension, acetone breath (fruity odor), hyperventilation (Kussmaul respirations), MS changes, abdominal pain.
What is the typical blood sugar level in DKA?
BS typically >300 (severity of DKA is not necessarily related to blood glucose levels)
What are the bicarbonate and pH levels in ketoacidosis?
Ketoacidosis (bicarbonate 0-15), low pH, and low carbon dioxide (PaCO2 10-30)
What are some diagnostic findings in DKA?
Ketones in urine, increased BUN, creatinine, and hyperkalemia
What is the treatment for DKA?
Insulin is infused at a slow continuous rate (regular insulin) until bicarbonate level is at least 15-18 and patient can eat.
How often are blood sugar levels taken during DKA treatment?
Hourly BS levels are taken.
What should be done when blood sugar levels reach 250-300?
IV fluid with concentrations of glucose are given to avoid rapid drop in BS.
What should patients do during illnesses to manage blood glucose?
Keep their insulin dosage the same and consume frequent small portions of carbohydrates to avoid hyperglycemia and DKA.
What is the guideline for sick days regarding insulin?
Take insulin as usual.
How often should blood sugar and urine ketones be tested on sick days?
Every 3-4 hours.
What should be done if elevated glucose levels or urine ketones are reported?
Report to your provider.
What is Hyperglycemic Hyperosmolar Nonketotic Syndrome?
A metabolic disorder that gradually occurs, most often of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness or medications that raise the demand for insulin (thiazides).
What are the predominant features of Hyperglycemic Hyperosmolar Nonketotic Syndrome?
Hyperosmolarity and hyperglycemia predominate with alterations in mental status.
What are some causes of Hyperglycemic Hyperosmolar Nonketotic Syndrome?
Cells not receptive to insulin, severe infection or illness, medications such as thiazides, and dialysis.
What are some clinical manifestations of Hyperglycemic Hyperosmolar Nonketotic Syndrome?
Hypotension, profound dehydration, tachycardia, alterations in consciousness, seizures, hemiparesis.
What is the blood glucose level indicating heavy-duty hyperglycemia?
> 600
What osmolality level is considered super high?
> 320
What is a key characteristic of the condition being assessed?
No ketoacidosis
What electrolyte imbalances may be present?
Electrolyte imbalances
What lab values are typically high in this condition?
High BUN and Creatinine
What neurological changes might occur?
MS changes (possible hallucinations)
What is the primary medical management for this condition?
FLUID REPLACEMENT
What role does insulin play in this condition?
Not as important as it is in DKA
What should be administered once blood sugar reaches 250-300?
Glucose concentrated fluid to prevent hypoglycemia
How long may treatment continue after metabolic abnormalities have resolved?
Treatment will continue well after metabolic abnormalities have resolved
It could take 3-5 days for neurological symptoms to resolve.
What are the long-term complications of diabetes?
Micro/macrovascular complications and neuropathy
What risk factors contribute to diabetic complications?
Hyperglycemia and hypertension
What type of blood vessels are affected in microvascular complications?
Small blood vessels
Which type of diabetes is more prevalent with microvascular complications?
Type one diabetes
What areas of the body are affected by microvascular complications?
Eyes, Kidneys, and Nerves
What is diabetic retinopathy?
Damage to the small blood vessels that nourish the retina
What are the three stages of diabetic retinopathy?
- Background, 2. Preproliferative, 3. Proliferative
What occurs in the background stage of diabetic retinopathy?
Asymptomatic stage with micro aneurysms that leak fluid
What happens in the proliferative stage of diabetic retinopathy?
Abnormal growth of new blood vessels on the retina that can rupture
What are symptoms of hemorrhaging in diabetic retinopathy?
Floaters/cobwebs in visual field, sudden visual changes
What is the leading cause of blindness among people aged 20-74?
Diabetic retinopathy
What treatment is used for advanced cases of diabetic retinopathy?
Argon Laser Photocoagulation
What is panretinal photocoagulation?
More than 1000 laser burns throughout the retina to stop new vessel growth
What is vitrectomy used for?
Performed for patients who already have vision loss
What is nephropathy?
Nephropathy is a condition where hyperglycemia causes overwork of the kidneys, allowing blood proteins to leak into the urine, thus increasing pressure in the blood vessels of the kidneys.
What are the clinical manifestations of nephropathy?
Symptoms of kidney failure along with frequent hypoglycemic episodes.
What assessments and diagnostics are used for nephropathy?
Albumin in the urine should be tested annually for microalbuminuria. If greater than 30mg/24hr on two consecutive tests, a 24 hr urine sample should be obtained and tested. Kidney function tests are also performed.
What is the medical management for nephropathy?
Control hypertension (ACE inhibitors, ARBs), prevention and treatment of UTIs, avoidance of nephrotoxic drugs, adjust medications as kidney function changes, low sodium and low protein diet, and treatment for kidney failure.
What is peripheral neuropathy?
Peripheral neuropathy occurs when high glucose damages the nerves, causing pain and sensation loss (paresthesia) and a burning sensation at night.
What are the medical management options for peripheral neuropathy?
Insulin therapy to delay onset or slow progression, treatment of pain with analgesics, tricyclic antidepressants, duloxetine, anticonvulsants (pregabalin or gabapentin), mexiletine, and transcutaneous electrical nerve stimulation.
What is autonomic neuropathy?
Autonomic neuropathy includes hypoglycemic unawareness, sudomotor neuropathy (lack of sweating), dryness of the feet, sexual dysfunction, and delayed gastric emptying.
What are macrovascular complications of diabetes?
Macrovascular complications involve large blood vessels and are more prevalent with type two diabetes, leading to CAD, CVD, PVD, heart attacks, and strokes.
What is the risk of myocardial infarction (MI) in diabetics?
MI is twice as common in men with diabetes and three times as likely in women with diabetes compared to those without diabetes.
What are the signs of peripheral vascular disease (PVD) in diabetics?
Signs include diminished peripheral pulses and intermittent claudication (pain) of the butt, thigh, or calf during walking.
What are the stages of shock?
The stages of shock include Initial, Compensatory, Progressive, and Refractory.
What occurs during the initial stage of shock?
The cell switches from aerobic to anaerobic metabolism, forming lactic acid due to low cardiac output.
What happens during the compensatory stage of shock?
The body attempts to correct low BP and cardiac output through biochemical and hormonal responses, leading to increased BP and cardiac output.
What are the signs and symptoms of progressive shock?
Signs include MAP <60, confusion, agitation, ARDS, pulmonary edema, decreased urine output, and increased BUN and creatinine.
What characterizes the refractory stage of shock?
The refractory stage is unmanageable and results in the shutdown of all organs, leading to death.
What is the treatment for shock?
Treatment includes addressing the underlying condition, administering IV fluids, blood products, vasopressors, and monitoring vital signs.
What are foot and leg problems in diabetics caused by?
Foot and leg problems are caused by neuropathy, peripheral vascular disease, and decreased ability to fight off infections.
What is the sequence of events leading to foot problems in diabetics?
- Soft tissue injury, 2. Formation of callus or fissure, 3. Injury goes unnoticed, 4. Serious infection develops.
What is the recommended treatment for diabetic foot problems?
Keep the patient off feet, administer antibiotics, control glucose levels, and encourage daily foot examinations.
