When to suspect hyperglycaemic emergency?

Question 1

What is diabetic ketoacidosis

Answer 1

Metabolic state characterised by: hyperglycaemia, metabolic acidosis, and ketonaemia.

Life threatening emergency.

May lead to: dehydration, electrolyte imbalances, MI, shock, cerebral oedema, and aspiration pneumonia.

Question 2

What is hyperosmolar hyperglycaemic state (HHS)

Answer 2

Rare but life-threatening emergency that typically occurs in older people with T2D and other co-morbidities

Develop severe hyperglycaemia usually over several weeks often due to a combination of acute illness and dehydration.

Present with urinary frequency, thirst, nausea, confusion, and severe dehydration.

Question 3

Clinical symptoms of hyperglycaemia

Answer 3

Polydipsia (thirst) and polyuria.
Weight loss
Abdominal pain, nausea, vomitting.
SOB
Lethargy, drowsiness, confusion.
History

Question 4

Clinical signs of hyperglycaemia

Answer 4

Fruity smell of acetone on the breath.
Tachypnoea - acidotic breathing
Dehydration (skin turgor, sunken eyes, prolonged capillary Reilly time)
Shock - tachycardia, hypotension, drowsiness, reduced urine output.

Question 5

Tests for hyperglycaemia crisis

Answer 5

Glucose test (11mmol+)
Ketones - urinary (2+) or capillary blood ketones (+3mmol/L).

Question 6

Precipitating factors of DKA and HHS

Answer 6

Infection
Inadequate insulin or non-adherence
New onset
Other Medical conditions (hypothyroidism or pancreatitis)
Drugs (corticosteroids, diuretics, atypical antipsychotic, sympathomimetic drugs such as salbutamol).

Question 7

What is hypoglycaemia defined as

Answer 7

Glucose levels less than 3.5mmol/L