Hyperglycemic Crisis

Question 1

DKA triad

Answer 1

uncontrolled hyperglycemia
metabolic acidosis
increased total body ketone concentration

Question 2

hhs characteristics

Answer 2

severe hypergly
hyperosmolality
dehydration in the absence of significant ketoacidosis

Question 3

___ is the most common cause of death in children and adolescents with t1dm

Answer 3

dka

Question 4

t/f dka has lower mortality rate in adults but have higher rates in elderly

Answer 4

true

Question 5

dka is caused by increased ___ and decreased ___

Answer 5

increased counterregulatory hormones, decreased insulin

Question 6

3 processes that result to hyperglycemia

Answer 6

increased gluconeogenesis
accelerated glycogenolysis
impaired glucose utilization by peripheral tissues

Question 7

effects of dka in adipose

Answer 7

release of ffa (lipolysis)

Question 8

effects of dka in liver

Answer 8

unrestrained hepatic fa oxidation to ketone bodies

Question 9

how to differentiate hhs and dka

Answer 9

presence of greater degree of dehydration

differences in insulin availability

Question 10

most common precipitating factor in hhs or dka

Answer 10

infection

Question 11

factors leading to severe dehydration and hhs

Answer 11

underlying illness that provokes the release of counterregulatory hormones
compromised access to water

Question 12

drugs that can cause hhs/dka

Answer 12

corticosteroids
thiazides
sympathomimetic agents
pentamidine

Question 13

t/f unknown causes of dka commonly occur in t1dm patients

Answer 13

true

Question 14

t/f hhs takes a short time frame while dka takes several days and weeks to develop

Answer 14

false, hhs takes several days and weeks while dka takes shorter time

Question 15

symptoms present in dka which are not present in hhs

Answer 15

nausea, vomiting, and diffuse abdominal pain

Question 16

symptoms present in hhs which are not present in dka

Answer 16

focal neurological signs

seizure

Question 17

basis for severity of dka

Answer 17

severity of metabolic acidosis (blood ph, bicarb, ketones)

presence of altered mental status

Question 18

t/f patients in hhs have less ketosis and greater hyperglycemia >600 mg/dl than dka

Answer 18

true

Question 19

augmented ketonemia is assessed by ___

Answer 19

nitroprusside reaction

Question 20

another test that can help diagnose blood ketone concentration in dka

Answer 20

serum b-hydroxybutyrate

Question 21

anion gap formula and normal value

Answer 21

na - (cl + hco)

normal: 7-9 meq/l
increased, met acid: 10-12 meq/l

Question 22

glucose levels in euglycemic dka

Answer 22

= 250 mg/dl

Question 23

range of leukocytosis counts

Answer 23

10,000-15,000 mm2

Question 24

t/f serum sodium is high on admission

Answer 24

false, it’s low

Question 25

t/f serum osmolality and mental alteration have a positive linear relationship

Answer 25

true

Question 26

low ___ can provoke cardiac dysrhythmia

Answer 26

low potassium

Question 27

other causes of high anion gap metabolic acidosis

Answer 27

lactic acidosis
drugs
acute chronic renal failure

Question 28

goals of fluid therapy

Answer 28

expansion of intravascular, interstitial, and intracellular volume

restoration of renal perfusion

Question 29

type of saline to administer for fluid therapy

Answer 29

isotonic saline 0.45 or 0.9%

Question 30

until when to administer fluid therapy

Answer 30

blood glucose <250 mg/dl
ketoacidosis is corrected

= 6-12 hrs

Question 31

when plasma glucose is ~200 mg/dl ____ should be added to replacement fluids

Answer 31

5% dextrose

Question 32

mainstay in treatment of dka

Answer 32

administration of regular insulin via continuous iv infusion or frequent subcutaneous/IM injections

Question 33

when to decrease insulin infusion rate

Answer 33

when plasma glucose reaches 200 mg/dl

Question 34

targeet glucose values for dka and hhs

Answer 34

150-200: dka

250-300: hhs

Question 35

t/f sc rapid acting insulin every 1-2 hrs = IV regular insulin

Answer 35

true

Question 36

treatment goal for potassium levels

Answer 36

normal range 4-5 meq/l

Question 37

t/f insulin treatment should be delayed until potassium concentration is restored to >3.3 meq/l

Answer 37

true, to avoid arrhythmias and respi muscle weakness

Question 38

t/f adult patients with ph < 6.9 shouldnt be given bicarbonate therapy

Answer 38

f, they can be given

Question 39

criteria for resolution of ketoacidosis

Answer 39

<200 mg/dl and two of the ff:
hco3 >13 meq/l
venous ph >7.3
anion gap < 12

Question 40

criteria for resolution of hhs

Answer 40

normal osmolality

normal mental status

Question 41

common complications

Answer 41

hypoglycemia and hypokalemia