Hyperglycemia and hypoglycemia

Question 1

A postprandial BG level of what is diagnostic of DM?

Answer 1

180 mg/dL

Question 2

What test finding is needed to definitively diagnose DKA?

Answer 2

Ketonuria

Question 3

What is the threshold above which glucosuria develops?

Answer 3

180 mg/dL

Question 4

Neuro s/sx are more prevalent in DKA or HHS?

Answer 4

HHS

Question 5

What neuro s/sx can be seen with DKA /HHS?

Answer 5

Seizures
Focal weakness
Lethargy
Coma

Question 6

What labs/tests, besides a CBC ad BMP, should a pt with suspected DKA/HHS get?

Answer 6

ABG
EKG
Phosphorus
Mg
Ketones

Question 7

Which has higher [BG] DKA or HHS?

Answer 7

HHS

Question 8

Which has an AG acidosis: DKA or HHS?

Answer 8

DKA

Question 9

What is the rate of fluid administration for DKA and HHS (same for both)?

Answer 9

15-20 ml/kg/hr

Question 10

When should the fluids be switched to 0.5 NS in the treatment of both DKA and HHS?

Answer 10

When Na normalizes

Question 11

When should dextrose be added in the treatment of DKA?

Answer 11

When BG reaches 250 mg/dL

Question 12

What should come first in the treatment of DKA/HHS: insulin or fluids?

Answer 12

Fluids

Question 13

What is the rate of insulin infusion in the treatment of DKA?

Answer 13

0.1 U/kg/hr

Question 14

When should insulin therapy be started relative to K replacement?

Answer 14

If the initial potassium is less than 3.3 mEq/L then DELAY insulin therapy until fluid and potassium replacement

Question 15

When is the use of bicarb indicated in the treatment of DKA?

Answer 15

• if pH is less than 6.90
• Severe life-threatening hyperkalemia
• Seizures

Question 16

How often should BG and a BMP be obtained during the treatment of DKA?

Answer 16

q2-4 hours

Question 17

What is a major complication of treating DKA/HHS? What are the s/sx that precede this?

Answer 17

Cerebral edema

HA, confusion, lethargy

Question 18

What treatments are associated with the development of cerebral edema in treating DKA/HHS?

Answer 18

Fluid and bicarb administration

Question 19

What must always be asked when a pt is diagnosed with DKA?

Answer 19

Why are they in it? (sepsis? med non-compliance?)

Question 20

What is the definition of hypoglycemia?

Answer 20

Less than 50-60 mg/dL

Question 21

What are the two broad categories of symptoms pts have with hypoglycemia?

Answer 21

Neuroglycopenia

Hyperepinephrinemic (sympathomimetic)

Question 22

How much oral glucose is given to symptomatic hypoglycemic patients (who are still conscious)?

Answer 22

300g (1200 cal)

Question 23

How much IV glucose is given to pts with hypoglycemia?

Answer 23

50 ml of 50% D50 or 1 mg/jg in kids

Question 24

What is the dose of glucagon given to hypoglycemic pts?

Answer 24

1 mg IM and 0.5 mg IM in peds

Question 25

What additional medication can be given to pts who take sulfonylureas who continue to have hypoglycemia?

Answer 25

Octreotide (prevent insulin secretion)