Hyperglycaemia

Question 1

What is the care objective for adult hyperglycaemia?

Answer 1

Adequate fluid replacement where indicated.

Question 2

What are the criteria for suspecting diabetic ketoacidosis?

Answer 2

Any patient with:

• Hx diabetes
• BGL >11mmol/L
• clinical features of DKA including confusion, dehydration, Kussmaul’s.

Question 3

What number of DKA patients present with low to moderate hyperglycaemia?

Answer 3

Half.

Question 4

What is considered low to moderate hyperglycaemia?

Answer 4

BGL 11-29 mmol/L

Question 5

Can DKA occur in patients without a history of diabetes?

Answer 5

Yes, occasionally.

Question 6

Kussmaul’s is often mistaken for…?

Answer 6

Anxiety-related hyperventilation. Any patient with BGL >11, signs of dehydration and hyperventilation requires transport.

Question 7

What factors/signs may help potentially differentiate DKA from HHS?

Answer 7

• typically older patients
• have higher BGL (>30)
• usually don’t present with DKA features

Question 8

Is there value in differentiating between hyperglycaemic crises pre-hospitally? What do these patients need?

Answer 8

No. Fluid replacement titrated to adequate perfusion is the aim of care in symptomatic patients.

Question 9

Is there benefit to administering fluid to DKA/HHS patients with adequate perfusion?

Answer 9

No. If Tx >1hr, consider 500mL per hour, but otherwise not required.

Question 10

Should patients be encouraged to administer their own insulin prior to hospital transport?

Answer 10

No.

Question 11

Why is intubation reserved for the severely obtunded patient in DKA/HHS?

Answer 11

Unable to achieve to compensatory respiratory alkalosis which may lead to poorer outcomes in DKA pts.

Question 12

List the 6 features of possible hyperglycaemia.

Answer 12

1. Confusion
2. Tachypnoea
3. Polyuria
4. Dehydration
5. Polydipsia
6. Kussmaul’s breathing

Question 13

List the criteria + clinical features required to indicate a patient requires fluids under this guideline.

Answer 13

BGL >11 mmol/L
with less than adequate perfusion 
AND:
1. Dehydration
2. Tachypnoea
3. Polydipsia
4. Polyuria
5. Polyphagia
6. Kussmaul's breathing
7. Hx of diabetes

Question 14

What is the fluid management for a less than adequately perfused hyperglycaemic patient? What are the other 2 elements to consider here?

Answer 14

Normal Saline 20mL/kg titrated to perfusion status, consult for further.
Consider reduced volume for elderly/cardiac or renal impairment.
Consider an antiemetic.