Hyperglycaemia

Question 1

Assessing degrees of dehydration

Answer 1

mild; dry mucous membranes, sunken eyes

moderate; as above plus reduced skin turgor

severe; as above plus severely unwell, poor capillary refill, skin turgor > 2s , thready pulse, hypotension

Question 2

What is diagnosis of DKA based on?

Diabetic ketoacidosis is a serious complication of Type I DM.

Answer 2

Diagnosis based on

glucose (blood glucose >11 mmol/L)

ketonuria (urine or blood)

acidosis (pH <7.30 venous blood)

HCO_{<strong>3</strong>} <15 mmol/L

Question 3

Diagnositic symptoms of DKA?

Answer 3

polydipsia

weight loss

dehydration

+ Kussmaul breathing

Question 4

Tx for DKA

(Sickness and vomiting, abdominal pain, muscular weakness)

Answer 4

500ml then another 500ml then another 500ml (saline). MUST ensure patient is rehydrated before giving insulin. 0.1units per kilo per hour.

As sugar moves into cells (insulin taking effect) potassium follows therefore px becomes hypokalaemic. Normal potassium 3.5 to 5.

Watch urine output to check hydration.

Red flag; peds until 22-23 yr old. Can die from cerebral oedema; therefore don’t give insulin until properly hydrated.

Question 5

Why rehydrate gradually with DKA?

Answer 5

to avoid rapid intracellular osmotic/ sodium shifts that may cause fatal CNS oedema.

Remember: with DKA and polydipsia, rapid fluid shift from intracellular compartments.

Question 6

What can be triggers for DKA?

Answer 6

undiagnosed type I diabetes

infections; commonly respiratory and urinary

acute pancreatitis

MI

omission of insulin dose

Question 7

How long do you continue IV insulin?

Answer 7

Until no ketones present in blood

Question 8

What is the danger of IV insulin in emergency situations?

Answer 8

Loss of potassium

(replace in IV fluids 0.9% saline + 40 mmol/L KCL)

Question 9

Does DVLA need to be informed about type I diabetes?

Answer 9

YES

Question 10

polydipsia is…

Answer 10

excessive thirst

Question 11

What markers of improvement should you look for with treatment of DKA patient?

Answer 11

• improvement in conscious level
• normalization of acidosis
• fall in blood glucose of around 3-5mmol/L per hour

Question 12

If there is a deteriation of consciousness with DKA treatment, what is a possible complication?

Answer 12

cerebral oedema

Question 13

DKA - if underlying cardiac/ renal problems, what must you always monitor?

Answer 13

central venous levels

Question 14

How much fluid is usually given for DKA patients in first 12-24 hours?

Answer 14

6 litres