Ketoacidosis and hyperosmolar hyperglycaemic states

Question 1

what is a ketone

Answer 1

chemical compound that forms when a specific kind of molecule contains a carbon atom double-bonded to an oxygen atom - knwon as a carbonyl group

Question 2

what does an excess production of ketones in blood lead to

Answer 2

acidity

Question 3

how does this occur in type 1

Answer 3

body cant use glucose for energy due to not enough insulin

Question 4

how might ketones be produced

Answer 4

body breaks down fat for fuel as cant use glucose for energy due to not enough insulin

Question 5

dangers of ketoacidosis

Answer 5

coma, death

Question 6

symptoms of ketoacidosis

Answer 6

nausea
extreme thirst
frequent urination
abdominal pain
confusion
acidic breath
vomitting
polyuria
ketonuria
lethargy
blurred vision

Question 7

initial managemet of ketoacidios s

Answer 7

fluid recuss and insulin therapy
saline 0.9%, insulin, potassium replacement

Question 8

when is oral fluids and subcutaneous insulin given

Answer 8

children who have mild DKA, are fully alert, not nauseous or vomiting and have no signs of dehydration

Question 9

what i’s increase insulin demand

Answer 9

inflammatoyr- pancreatiitis, cholecystiis
intoxication- alcohol
infections- pneumonia
infarction
iatrogenic- steroids, surgery

Question 10

what is serum osmolality

Answer 10

measure of electrolyte- water balance

Question 11

what doe sit mean if serum osmolality is raised

Answer 11

you are dehydrated

Question 12

what is Hyperglycaemic Hyperosmolar Syndrome

Answer 12

extreme hyperglycemia, dehydration, and increased serum osmolality, without significant ketoacidosis

Question 13

clinical presentation of HHS

Answer 13

dehydration due to polyuria
polydipsia
nausea and vomitting
stupor/ coma
renal impairment
sodium often high / normal or raised

Question 14

what is HHS charcaterised by

Answer 14

hyperglycaemia >33.3mol
hyperosmolality serum >320mmol

Question 15

management of HHS

Answer 15

fluid replacement to reduce osmolality
sodium
low dose iV insulin if significant ketones

Question 16

who does HHS more occur in

Answer 16

T2DM

Question 17

who does ketoacidosis mostly occur in

Answer 17

T1DM

Question 18

how do ketone bodies cause nausea and vomitting

Answer 18

ketone bodies can stimulate chemotrigger zone in brain which stimulates emetic centre in medulla

Question 19

how do ketones cause acidosis

Answer 19

tketone bodies can give off h+ ions
> h+ moves into ICF
> k+ leaves ICF
insulin needed to drive K+ back into cells
leads to arryhtmias and ileus

Question 20

what does water follow

Answer 20

glucose

Question 21

how does hyperosmolarity occur

Answer 21

increased glucose, reduced water
glucose draws water out from organs

Question 22

fluid resus in ketoacidosis

Answer 22

• 1000mL NaCl 0.9% in the first hour
• 20000mL NaCl by end of hour 2
• 30000mL NaCl by end of hour 4

Question 23

onset of DKA v HHS

Answer 23

hhs is days
dka is hours