Hyperglycemic Emergencies

Question 1

What are two life threatening complications due to diabetes, how should the be treated

Answer 1

Diabetic ketoacidosis and Hyperglycemic hyperosmolar State/ aggrestive hydration, insulin therapy, electrolyte replacement

Question 2

What is the triad of DKA, other symptoms

Answer 2

uncontrolled hyperglycemia, metabolic acidosis, ketosis/ N/V, abdominal pain

Question 3

What is the traid of HHS

Answer 3

Severe hyperglycemia, Hyperosmolarity, Dehydration

Question 4

T/F: DKA onset is fast and relies on ketoacidosis to replace glucose while HHS is slow and able to avoid lipolysis and ketone production

Answer 4

True

Question 5

What are the five precipitating Is for risk factors/others

Answer 5

Infection, Inadequate insulin therapy, infarction (myocardial), initial-onset diabetes, infancy/ pancreatitis, stroke, medication

Question 6

What is the pathophysiology of hyperglycemic emergencies

Answer 6

Absolute or relative insulin deficiency PLUS increased circulatory levels of counter-regulatory hormones CAUSING increased hepatic glucose production, less peripheral insulin activity, hypergylcemia

Question 7

What is the equation for serum osmolarity

Answer 7

(2 x Na) PLUS (Glucose/18) PLUS (BUN/2.8)

Question 8

What is the equation for Anion gap

Answer 8

Na MINUS (Cl PLUS HCO3)

Question 9

What are symptoms of hyperglycemia

Answer 9

Dry mouth, polydipsia (increased thirst), blurred vision, weakness, headache, polyuria (frequent urination)

Question 10

What are the symptom onset for DKA, HHS

Answer 10

less than 24 hours, days to weeks

Question 11

What are the clear signs of HHS

Answer 11

Glucose greater than 600, arterial pH greater than 7.30, serum osmolarity greater than 320

Question 12

What are other causes for anion gap metabolic acidosis

Answer 12

CAT-MUDPILES

Question 13

What lab is a good way to tell if acidosis is present besides pH

Answer 13

bicarbonate is greater than 18 mEq/L

Question 14

What is the first line therapy for DKA/HHS

Answer 14

Fluid therapy: administer 0.9% NaCl at 500 ml to 1000 ml per hour during the first 1 to 2 hours

Question 15

What should be done after initial fluid therapy is given for fluid hydration

Answer 15

Evaluate corrected serum sodium

Question 16

What fluid therapy changes should occur if corrected serum sodium is high/normal, low

Answer 16

0.45% NaCl at 250-500 ml/h depending on state of hydration/ 0.9% NaCl at 250-500 ml/ depending on state of hydration

Question 17

What should the next step be after fluid therapy has been reevaluated

Answer 17

When plasma or capillary glucose reaches (11.1 to 13.9 mmol/l or 200-250 mg/dl for plasma glucose) then change to 5% dextrose with 0.45%NaCl until ketoacidosis resolves

Question 18

What are the goals with IV fluids

Answer 18

correct hydration via intravascular expansion, restore tissue perfusion, reduce insulin resistance

Question 19

What is the second line for DKA/HHS, how should it be administered

Answer 19

Insulin therapy: 0.1 units per kg IV bolus THEN 0.1 units per kg per hour IV insulin infusion

Question 20

When the glucose reaches 150- 250 mg/dl what should be done for the insulin dose

Answer 20

Reduce insulin 0.1 units per kg SC every two hours to maintain glucose until resolution of ketoacidosis

Question 21

How is potassium replace in hyperglycemic emergencies if less than 3.3 mmol/L

Answer 21

If serum potassium is less than 3.3 mmol/l HOLD insulin and give 10-20 mmol/hour of KCL until serum potassium is greater than or equal to 3.3mmol

Question 22

How should potassium be replaced in hyperglycemic emergenicies and serum potassium is greater than 3.3 mmol/l but less than 5 mmol/l, greater than 5

Answer 22

Add 20-40 mmol/l of KCL in each liter of IV fluid to keep serum potassium at 4 to 5 mmol/l, do not give potassium but check every 2 hours

Question 23

T/F: The best way to treat bicarbonate is to correct the ketoacidosis unless less than 6.9

Answer 23

True

Question 24

What is the equation for corrected sodium

Answer 24

1.6 (serum glucose/100) PLUS measured serum sodium

Question 25

When should patient transition to SQ insulin for DKA

Answer 25

Blood glucose is less than 200 mg/dl for DKA or 300 mg/dl for HHS PLUS bicarbonate greater than 15 mEq/L, venous pH is greater than 7.3, anion gap is less than or equal to 12mEq/L (at least two/three alltogether)

Question 26

When should a patient transition to SQ insulin for HHs

Answer 26

normal osmolarity and return of normal mental status

Question 27

T/F: Insulin must be administered two hours after IV infusion is stopped

Answer 27

True

Question 28

T/F: When patients have high glucose in the blood their sodium can be decievingly low and will not look correct until glucose is controlled

Answer 28

True