Hyperglycemic Crisis Flashcards
DKA triad
uncontrolled hyperglycemia
metabolic acidosis
increased total body ketone concentration
hhs characteristics
severe hypergly
hyperosmolality
dehydration in the absence of significant ketoacidosis
___ is the most common cause of death in children and adolescents with t1dm
dka
t/f dka has lower mortality rate in adults but have higher rates in elderly
true
dka is caused by increased ___ and decreased ___
increased counterregulatory hormones, decreased insulin
3 processes that result to hyperglycemia
increased gluconeogenesis
accelerated glycogenolysis
impaired glucose utilization by peripheral tissues
effects of dka in adipose
release of ffa (lipolysis)
effects of dka in liver
unrestrained hepatic fa oxidation to ketone bodies
how to differentiate hhs and dka
presence of greater degree of dehydration
differences in insulin availability
most common precipitating factor in hhs or dka
infection
factors leading to severe dehydration and hhs
underlying illness that provokes the release of counterregulatory hormones
compromised access to water
drugs that can cause hhs/dka
corticosteroids
thiazides
sympathomimetic agents
pentamidine
t/f unknown causes of dka commonly occur in t1dm patients
true
t/f hhs takes a short time frame while dka takes several days and weeks to develop
false, hhs takes several days and weeks while dka takes shorter time
symptoms present in dka which are not present in hhs
nausea, vomiting, and diffuse abdominal pain
symptoms present in hhs which are not present in dka
focal neurological signs
seizure
basis for severity of dka
severity of metabolic acidosis (blood ph, bicarb, ketones)
presence of altered mental status
t/f patients in hhs have less ketosis and greater hyperglycemia >600 mg/dl than dka
true
augmented ketonemia is assessed by ___
nitroprusside reaction
another test that can help diagnose blood ketone concentration in dka
serum b-hydroxybutyrate
anion gap formula and normal value
na - (cl + hco)
normal: 7-9 meq/l
increased, met acid: 10-12 meq/l
glucose levels in euglycemic dka
= 250 mg/dl
range of leukocytosis counts
10,000-15,000 mm2
t/f serum sodium is high on admission
false, it’s low
t/f serum osmolality and mental alteration have a positive linear relationship
true
low ___ can provoke cardiac dysrhythmia
low potassium
other causes of high anion gap metabolic acidosis
lactic acidosis
drugs
acute chronic renal failure
goals of fluid therapy
expansion of intravascular, interstitial, and intracellular volume
restoration of renal perfusion
type of saline to administer for fluid therapy
isotonic saline 0.45 or 0.9%
until when to administer fluid therapy
blood glucose <250 mg/dl
ketoacidosis is corrected
= 6-12 hrs
when plasma glucose is ~200 mg/dl ____ should be added to replacement fluids
5% dextrose
mainstay in treatment of dka
administration of regular insulin via continuous iv infusion or frequent subcutaneous/IM injections
when to decrease insulin infusion rate
when plasma glucose reaches 200 mg/dl
targeet glucose values for dka and hhs
150-200: dka
250-300: hhs
t/f sc rapid acting insulin every 1-2 hrs = IV regular insulin
true
treatment goal for potassium levels
normal range 4-5 meq/l
t/f insulin treatment should be delayed until potassium concentration is restored to >3.3 meq/l
true, to avoid arrhythmias and respi muscle weakness
t/f adult patients with ph < 6.9 shouldnt be given bicarbonate therapy
f, they can be given
criteria for resolution of ketoacidosis
<200 mg/dl and two of the ff:
hco3 >13 meq/l
venous ph >7.3
anion gap < 12
criteria for resolution of hhs
normal osmolality
normal mental status
common complications
hypoglycemia and hypokalemia
