Hyperglycemia Flashcards
What should be measured if a patient has hyperglycaemia and suspected DKA or HHNS?
Blood ketone levels if possible
What is the recommended IV fluid for a patient with signs of hypovolaemia or poor perfusion?
0.9% sodium chloride IV
1 litre for an adult over one hour; 20 ml/kg for a child over one hour. Repeat as required.
When should backup from a Paramedic be requested?
If the patient has signs of hypovolaemia or poor perfusion
When should backup from an ICP/CCP be requested?
If the patient has severe shock
What should be recommended for a patient with suspected DKA or HHNS?
Transport to an ED by ambulance
What develops in patients with type one diabetes who receive insufficient insulin?
Diabetic ketoacidosis (DKA)
What are common characteristics of patients with DKA?
Hyperglycaemia, hypovolaemia, acidosis
Blood glucose concentration usually greater than 20 mmol/litre.
What is a common sign of acidosis in DKA patients?
Tachypnoea
What may the patient’s breath smell like in DKA?
Fruity smell from ketones
Is there a role for out-of-hospital administration of insulin in DKA?
No
What is the physiological response to metabolic acidosis?
Hyperventilation
What condition may occur in patients on SGLT2 inhibitors such as empagliflozin?
Euglycaemic DKA
What is hyperosmolar hyperglycaemic non-ketotic state (HHNS)?
Clinically significant hyperglycaemia without acidosis in type two diabetes
What are other terms for hyperosmolar hyperglycaemic non-ketotic state (HHNS)?
- Hyperosmolar non-ketosis (HONK)
- Hyperosmolar hyperglycaemic state (HHS)
What is a potential risk for patients with diabetes who are unwell?
Significant comorbidities
What should be done if a patient with diabetes shows no signs of clinically significant hyperglycaemia but is unwell?
Refer the patient to a doctor
What should be avoided in treating hypovolaemia caused by hyperglycaemia?
Rapid boluses of IV fluid
What is a risk associated with rapid boluses of IV fluid in hyperglycaemia?
Cerebral oedema
Why can rapid boluses of fluid cause cerebral oedema?
They may cause a rapid fall in glucose and osmolality
Who is most at risk of adverse effects from cerebral oedema?
Children and young adults
euglycemic ketoacidosis
someone has metabolic acidosis and ketosis, but their blood glucose levels are normal or near normal.
why dose DKA cause osmotic diuresis
DKA causes osmotic diuresis because severe hyperglycemia overwhelms the kidneys’ ability to reabsorb glucose, leading to glucose spilling into the urine, which draws water and electrolytes along with it due to osmotic pressure, resulting in excessive urine output and dehydration.
why do ketones get produced in DKA
because fat is broken down to be used as energy, as glucose cannot get into the cell
