Medicine/Diabetic emergency

Question 1

DKA signs and symptoms

Answer 1

Signs/Definition

• Blood ketones >3mmol/L
• BM >11
• Blood pH <7.3

Symptoms

• Urinary frequency
• Polydipsia
• Nausea
• breath that smells fruity
• deep or fast breathing
• feeling very tired or sleepy
• confusion
• passing out

Question 2

DKA causes

Answer 2

• Infection
• Non/poor compliance
• Trauma/surgery
• Medication interaction esp steriods
• Elicit drugs and alcohol
• pregnancy
• Menstruation

Question 3

DKA treatment

Answer 3

• A to E call for help
• IV fluids NaCl 0.9%
• Fixed rate insulin pump 0.1 units/kg/hr
• Continue any long acting S/C insulin
• When BM <14 10% glucose IV
• Add potassium according to U+Es (40mmol KCL per L of NaCl)
• Monitor: ABG (pH + ketones), BM, U+Es
• When eating and drinking give normal S/C regime at meal time and, if nothing happens, 1 hour later stop IV fluids and insulin

Question 4

HHS signs and symptoms

Answer 4

Signs/Definition

• Hypovolaemic
• Hyperglycaemia >30
• <3mmol/L ketones
• +/- acidosis
• Serum osmolality >320 mosm/kg
  
  • 2*Na + glucose + urea

Symptoms

• Polydipsia
• Dry mouth
• Urinary frequency
• Drowsiness, confusion
• Hallucinations
• Vision loss
• Convulsions
• Coma

Question 5

HHS causes

Answer 5

• Infection
• Non/poor compliance
• Medication interaction

Question 6

HHS treatment

Answer 6

• IV NaCl 0.9% 1L in first hour
  
  • Change to 0.45% NaCl if osmolality isn’t declining (initial increase expected)
• IV low dose FRII
  
  • If mild ketones give immediately 0.05units/kg/hr
  • If no ketones start once glucose falls at rate of <5mmol/L/Hr
• Replace potassium on U+E
  
  • 3.5-5.5 –> 40mmol
• Monitor: fluid balance, BM, U+E, osmolality

Question 7

Hypoglycaemia signs and symptoms

Answer 7

Signs/Definition

• BM <4

Symptoms

• feeling hungry
• sweating
• feeling shaky or trembling
• dizziness
• feeling tired
• blurred vision
• confusion
• Slurred speech or clumsiness (like being drunk)
• seizures (fits)
• collapsing or passing out

Question 8

Hypoglyaemia treatment

Answer 8

• 15-20g of quick acting carb PO e.g. glucogel or orange juice
• If consciousness affected
  
  • Glucagon injection 1mg IM, if no IV access
  • 10% glucose IV, if IV access
• Check BMs 10-15 mins after each intervention
• Follow up with long acting carb snack