glucose disorders Flashcards
what is the 3 things that overlap in a patient with DKA (diabetic ketoacidosis)
uncontrolled hyperglycemia
metabolic acidosis
increased ketone concentration
hyperglycemia results from what 3 pathophysiological thing
- increased gluconeogenesis
- accelerated glycogenolysis
- impaired glucose utilization
what is the most common precipitating factor of hyperglycemic emergencies
infection
what 3 electrolyte imbalances are common in DKA?
- potassium - elevated
- sodium - false lowering
- phosphate - decreases with therapy
what is the purpose of IV fluids in hyperglycemic emergencies
volume expansion and restoration of renal perfusion
what is thought to be the pathogenesis of HHS
insulin is secreted but inadequate to remove glucose from blood
what are 4 precipitating factors for hyperglycemic emergency other than an infection
- noncompliance with insulin
- new onset DM
- acute major illness
- drugs
upon physical exam, HHS problems often have what 4 things?
- dehydration
- hypotension
- decreased skin turgor
- dry mucous membranes
what hyperglycemic emergency is characterized by very high glucose levels, often over 600
HHS
what are the 3 categories of treatment for hyperglycemic emergency
- IV fluids
- Insulin
- electrolyte management
Initial fluid replacement should use what and in hyperglycemic emergency? In what time period should deficits be corrected?
0.9% NaCl
within 24 hours
once glucose reaches what levels should fluid be switched from nacl?
what should it be switched to
200 for dka
300 for HHS
switch to D5 + 0.45% NaCl
what is the goal of reuced blood glucose in the first hour of insulin treatment
50-70 mg/dL
what is the goal BG for DKA with continuous IV insulin treatment?
HHS?
DKA = 150-200 HHS = 200-300
when can transition to SQ insulin be initiated for DKA
BG less than 200 PLUS 2 of the following: 1. bicarbonate greater than 15 2. pH greater than 7.3 3. anion gap less than 12
when can transition to SQ insulin be initiated for HHS?
- normal serum osmolality
2. normal mental status
how long of an overlap between discontinuation of insulin infusion and SQ administration should be allowed
1-2 hour overlap
what electrolyte abnormality is common in treatment of hyperglycemic emergency? why?
hypokalemia; caused due to insulin moving K into cell.
how much potassium should be added to each liter of fluid once serum K is less than 5.2
20-30 mEq of K
people with what K concentration should not receive insulin therapy
K less than 3.3
when is bicarbonate given in hyperglycemic emergencies?
cases with a pH less than 6.9
when is phosphate given in hyperglycemic emergencies?
- cardiac dysfunction
- anemia
- respiratory depression
- phosphate level less than 1
