Hyperglycemia and hypoglycemia Flashcards
A postprandial BG level of what is diagnostic of DM?
180 mg/dL
What test finding is needed to definitively diagnose DKA?
Ketonuria
What is the threshold above which glucosuria develops?
180 mg/dL
Neuro s/sx are more prevalent in DKA or HHS?
HHS
What neuro s/sx can be seen with DKA /HHS?
Seizures
Focal weakness
Lethargy
Coma
What labs/tests, besides a CBC ad BMP, should a pt with suspected DKA/HHS get?
ABG EKG Phosphorus Mg Ketones
Which has higher [BG] DKA or HHS?
HHS
Which has an AG acidosis: DKA or HHS?
DKA
What is the rate of fluid administration for DKA and HHS (same for both)?
15-20 ml/kg/hr
When should the fluids be switched to 0.5 NS in the treatment of both DKA and HHS?
When Na normalizes
When should dextrose be added in the treatment of DKA?
When BG reaches 250 mg/dL
What should come first in the treatment of DKA/HHS: insulin or fluids?
Fluids
What is the rate of insulin infusion in the treatment of DKA?
0.1 U/kg/hr
When should insulin therapy be started relative to K replacement?
If the initial potassium is less than 3.3 mEq/L then DELAY insulin therapy until fluid and potassium replacement
When is the use of bicarb indicated in the treatment of DKA?
- if pH is less than 6.90
- Severe life-threatening hyperkalemia
- Seizures
How often should BG and a BMP be obtained during the treatment of DKA?
q2-4 hours
What is a major complication of treating DKA/HHS? What are the s/sx that precede this?
Cerebral edema
HA, confusion, lethargy
What treatments are associated with the development of cerebral edema in treating DKA/HHS?
Fluid and bicarb administration
What must always be asked when a pt is diagnosed with DKA?
Why are they in it? (sepsis? med non-compliance?)
What is the definition of hypoglycemia?
Less than 50-60 mg/dL
What are the two broad categories of symptoms pts have with hypoglycemia?
Neuroglycopenia
Hyperepinephrinemic (sympathomimetic)
How much oral glucose is given to symptomatic hypoglycemic patients (who are still conscious)?
300g (1200 cal)
How much IV glucose is given to pts with hypoglycemia?
50 ml of 50% D50 or 1 mg/jg in kids
What is the dose of glucagon given to hypoglycemic pts?
1 mg IM and 0.5 mg IM in peds
What additional medication can be given to pts who take sulfonylureas who continue to have hypoglycemia?
Octreotide (prevent insulin secretion)
