SAQ 5 Flashcards
A 34-year-old female with a history of type 1 diabetes presents with vomiting and abdominal pain. She reports attending a barbecue yesterday and has been vomiting since this morning. As she has not been eating she has omitted her usual insulin today. A primary survey is undertaken and investigations are requested.
5a) What would an ABG show for pH and bicarbonate? (2)
5a) ABG for pH <7.3 (any value below 7.3 would be correct).
Bicarb level would be <15kPa
A 34-year-old female with a history of type 1 diabetes presents with vomiting and abdominal pain. She reports attending a barbecue yesterday and has been vomiting since this morning. As she has not been eating she has omitted her usual insulin today. A primary survey is undertaken and investigations are requested.
5b) The patient has diabetic ketoacidosis. Inadequate insulin dose and lack of insulin compliancy are risk factors for DKA. Name two other risk factors. (2)
5b) Acute illness - MI, pancreatitis
Stress - trauma, surgery
A 34-year-old female with a history of type 1 diabetes presents with vomiting and abdominal pain. She reports attending a barbecue yesterday and has been vomiting since this morning. As she has not been eating she has omitted her usual insulin today. A primary survey is undertaken and investigations are requested.
5c) Urinanalysis showed ketones +++. How should the patient be managed in the first instance? (2)
5c) 1L (0.5) 0.9% Sodium chloride (0.5) IV (0.5) over 1 hour (0.5)
A 34-year-old female with a history of type 1 diabetes presents with vomiting and abdominal pain. She reports attending a barbecue yesterday and has been vomiting since this morning. As she has not been eating she has omitted her usual insulin today. A primary survey is undertaken and investigations are requested.
5d) Fluids are commenced and an intravenous fixed rate infusion is started at 0.1 unit/kg/hour. Monitoring is required as incorrect fluid therapy can lead to complications. What are young people particularly vulnerable to from fluid resuscitation in DKA? (1)
5d) Cerebral oedema
A 34-year-old female with a history of type 1 diabetes presents with vomiting and abdominal pain. She reports attending a barbecue yesterday and has been vomiting since this morning. As she has not been eating she has omitted her usual insulin today. A primary survey is undertaken and investigations are requested.
5e) How does DKA compare to HHS? (2)
5e) DKA -there is hyperglycaemia with ketones produced, this is a diagnostic marker (>3mmol/l) for DKA. In HHS, there is hyperglycaemia without the production of ketones or acidosis.
A 34-year-old female with a history of type 1 diabetes presents with vomiting and abdominal pain. She reports attending a barbecue yesterday and has been vomiting since this morning. As she has not been eating she has omitted her usual insulin today. A primary survey is undertaken and investigations are requested.
5f)What is hyperglycaemia value diagnostic for DKA?
5f) >11mmol/L
