hyperglycaemia

Question 1

fluids in hyperglycaemia

Answer 1

• Gain IV access.
• Administer 0.9% sodium chloride IV if the patient has signs of hypovolaemia or poor perfusion:
  a) 1 litre for an adult over one hour.
  b) 20 ml/kg for a child over one hour.
  c) Repeat as required.

Question 2

DKA develops in patients with

Answer 2

type one diabetes who receive insufficient insulin, leading to clinically significant hyperglycaemia.

Question 3

patients with DKA have

Answer 3

ū Hyperglycaemia with a blood glucose concentration that is usually greater than 20 mmol/litre.
ū Hypovolaemia from a combination of osmotic diuresis secondary to hyperglycaemia, reduced oral intake and vomiting.
ū Acidosis from metabolism of fatty acids to ketones. The most common sign of this is tachypnoea. The patient’s breath may have a fruity smell from ketones.

Question 4

Patients with type two diabetes can develop clinically significant hyperglycaemia without acidosis, because

Answer 4

there is sufficient insulin present to prevent cells shifting to predominantly metabolising fatty acids. (HHS)

Question 5

patients with diabetes that are unwell are at an increased risk of

Answer 5

are at increased risk of developing infection, silent myocardial ischaemia and metabolic or electrolyte disorders. Have a low threshold for referring
the patient to a doctor, even if there are no signs of clinically significant hyperglycaemia.

Question 6

rapid boluses of IV fluid are avoided if the cause of hypovolaemia is hyperglycaemia unless…… and why?……

Answer 6

rapid boluses of IV fluid are avoided if the cause of hypovolaemia is hyperglycaemia, unless the patient has severe shock. This is because rapid boluses of IV fluid may contribute to cerebral oedema:
ū Rapid boluses of fluid may cause a rapid fall in glucose (by dilution) and this causes a rapid fall in osmolality. A rapid fall in osmolality causes water to shift into the brain and this may cause cerebral oedema.
ū Children and young adults are most at risk of the adverse effects from cerebral oedema because they do not have cerebral atrophy.