Uro/endo week: diabetic metabolic emergencies Flashcards
What are the 3 diabetic metabolic emergencies
- diabetic ketoacidosis
- hyperosmolar hyperglycaemic state
- hypoglycaemia
What are the 4 main diagnostic features of diabetic ketoacidosis
- severe dehydration
- metabolic acidosis
- ketosis
- hyperglycaemia
What causes dehydration and metabolic acidosis in diabetic ketoacidosis
High circulating glucose –> osmotic diuresis by kidneys –> dehydration
Peripheral lipolysis –> increase in circulating free fatty acids, converted to acid ketones in liver –> metabolic acidosis
Symptoms of of diabetic ketoacidosis
- low BP if severe
- deep rapid breathing (compensation for metabolic acidosis)
- ketone breath smell
- abdominal pain
- may have confusion
- vomiting
- headache
- severe dehydration
What are the 3 main features of hyperosmolar hyperglycaemia state
- hyperglycaemia
- hyperosmolality (leading to dehydration)
- mild or no ketosis
Why is there mild or no ketosis in hyperosmolar hyperglycaemia state
Insulin levels are still sufficient to inhibit hormone-sensitive lipase from breaking down fat tissue (inhibited hepatic ketogenesis)
What might precipitate a hyperosmolar hyperglycaemia state
- infection (particularly pneumonia)
- MI
- stroke
- other acute illness
What types of diabetic treatment can lead to hypoglycaemia
- Insulin
- Sulfonylurea
Differentiating DKA and HHOS in terms of symptoms
DKA has ketosis, abdominal pain, rarely coma
HHOS has no ketosis, frequent coma, rarely abdominal pain
Both have dehydration
DKA and HHOS
-in which type of diabetes do each occur
DKA: type 1
HHOS: type 2 (so no ketosis)
Is mortality rate higher in DKA or HHOS
HHOS
Definition of lactic acidosis
Which diabetic drug is it a complication of
Metabolic acidosis
No significant hyperglycaemia
No ketosis
Complication of metform
(tx is rehydration)
Autonomic symptoms in hypoglycaemia
sweating anxiety hunger pallor tremor palpitations
Neurogenic symptoms in hypoglycaemia
confusion drowsiness seizures coma personality change focal neurology
What 2 kinds of mild complications of insulin therapy may occur at injection site
- Lipohypertrophy
2. Local allergic reactions
