Glycemic Emergencies

Question 1

HHS lab findings

Answer 1

high Na osm (>320), extreme hyperglycemia (>600), and sever dehydration

Question 2

Causes of DKA/HHS

Answer 2

Sepsis/infection, medication non-complinace, pancreatitis, CV event, dehydration, pregnancy, steroids, SLGT02 inhibitors, atypical antipsychotics, thiazides

Question 3

DKA: mild, moderate, severe

Answer 3

Sugar >250, positive serum/urine ketones
Mild: pH >7.25, bicarb >15, AG >10, alert
Mod: Ph > 7, bicarb ?>10, AG > 12, alert/drowsy
Severe pH <7 bicarb <10, AG > 12, supor coma

Question 4

HHS

Answer 4

Glucose >600, ph >7.3, small ketones, eleveted serum osm, stupor/coma

Question 5

hyperglycemic emergencies goal

Answer 5

Restore acid base balance and hydration

Question 6

Tx for hyperglycemic emergencies - dehydration

Answer 6

1. Dehydration: Isotonic saline, switch to 1/2 NS when volume resusciated
2. Add dextrose to fluid when glucose <300
3. for HHS, do not overhydrate - replace 50% fluid deficit over 12 hours

Question 7

Tx for hyperglycemia emergencies – hyperglycemia reversal

Answer 7

1. IV regular insulin is easy to titrate ( or lispro/aspart in mild-moderate DKA)
2. Change to subcu when patient eating.
3. Long acting insulin should be overlapped with IV insulin by 1 - 2 hours

Question 8

Tx for hyperglycemia - electrolytes

Answer 8

1. q2-4hrs electrolytes, BUN, Cr, venous pH, glucose
   2 Replace K when 5, goal is >4
2. GIve K 20-30meq with each liter of fluids

Question 9

Why anticoagulate in DKA?

Answer 9

Proinflammatory state has higher risk of VTE

Question 10

Definition of hypoglycemia and causes

Answer 10

gluc <72 - autonomic changes
-incorrect nsulin use
-poor carb intake
alcohol use that suppresses sugar production 
too much exercise
illness

Question 11

Tx for hypoglycemia

Answer 11

15g glucose, or IV/IM glucacon if severe.

Question 12

DM-1 Tx in hospital

Answer 12

basal-bolus with correction if patient eating

Question 13

Riks of DPP-4 inhibitors

Answer 13

can exacerbate HF

Question 14

Preoperative care for DM

Answer 14

DM1: continue basal insulin via insulin infusion or lower dose of basal subcu insulin and IV glucose

Check blood glucose every 4 hours in fasting patient and every hour with insulin infusion.