Acute Complications Of Diabetes

Question 1

Dissociation of ketone bodies causes?

Answer 1

Hydrogen ions and anions, anion gap metabolic acidosis

Question 2

How does insulin deficiency cause acidosis?

Answer 2

It causes lipolysis so increased fatty acids and therefore ketones leading to acidosis

Question 3

How to manage acidosis?

Answer 3

Intracellular buffering of H and K ions
Hyperventilation
Renal excretion of H ions

Question 4

Diabetic ketoacidosis precipitating factors?

Answer 4

Mud pie
Myocardial infarction 
Unidentifiable
Drugs: steroids
Previously undiagnosed type 1
Infections
Error/missed insulin administration

Question 5

Signs of diabetic ketoacidosis?

Answer 5

Dry mouth, sunken eyes hypothermia, weakness malaise thirst, smell of ketones hyperventilation polyuria

Question 6

How to measure acidosis?

Answer 6

PH less than 7.3 0r bicarb less than 14mmol/l

Question 7

Succussion splash?

Answer 7

Bowels stop working due to acidosis, fluid accumulates, stomach contents splashing about

Question 8

Ketone measurement with?

Answer 8

Plasma hydroxybutyrate- anything above 3 is ketoacidosis

Question 9

How to manage diabetic ketoacidosis?

Answer 9

IV fluids, saline with K
Urinary catheter
Intravenous insulin 0.1 unit/kg/hr
Prevent clots-heparin

Question 10

Hyperosmolar hyperglycaemic state doesn’t cause?

Answer 10

Don’t develop ketoacidosis

Question 11

HHS mortality?

Answer 11

30% thrombosis

Question 12

HHS management?

Answer 12

1. Correct dehydration
2. IV saline K
3. IV insulin 0.05 unit/kg/hour
4. antibiotics
5. heparin

Question 13

Symptoms of hypoglycaemia?

Answer 13

Shaky, fast heartbeat, sweating, feeling hot dizzy, blurry vision, weakness and headache, palpitations, hunger nausea

Headache
Is sweating
T achy cardio
Irritable
Restless
Excessive hunger
Depression/ dizzy

Neuroglycopaenic

Question 14

Hypoglycaemia values?

Answer 14

Less than 4

Clinical syndrome describes when the nervous system becomes glucose deficient or neuroglycopaenic

Question 15

Medication that can cause hypoglycaemia?

Answer 15

Sulfonylureas, glicalazide

Insulin

Question 16

Treatment for hypoglycaemia?

Answer 16

Minor: 20g carbohydrate sugary drink etc or glucose gel

Hypoglycaemic coma:
I’m or IV glucagon 1mg
IV dextrose 25g

Question 17

Mortality rates DKA?

Answer 17

5%

Question 18

Hyperventilation in DKA is called?

Answer 18

Kussmaul respiration

Question 19

HHS affects?

Answer 19

Over 40 years usually, precipitating causes steroids, diuretics and sugar

Question 20

How to calculate osmolality?

Answer 20

Potassium + sodium x2 + urea + blood sugar

Normally between 280 and 300mosom/kg

Question 21

When would you switch from IV insulin to subcutaneous?

Answer 21

When ketones less than 2 and ph normal

Question 22

Diabetic ketoacidosis mortality normally is?

Answer 22

5%

Question 23

Who get HHS when compared to diabetic ketoacidosis?

Answer 23

DKA- young

HHS- over 40s

Question 24

What are precipitating causes for HHS?

Answer 24

Previously undiagnosed, steroids diuretics, sugar

Question 25

With a mild/moderate hypo what should you do?

Answer 25

If conscious and can swallow
Give 5 teaspoons glucose powder in water, tests blood glucose after 15 mins
Then repeat up to 3 Times

Then img glucagon I’m