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Endocrinology, Nephrology, Urology, And Breast Surgery > Diabetic Emergencies > Flashcards

Diabetic Emergencies Flashcards

1
Q

What blood glucose level causes autonomic and neuroglycopenic symptoms occur

A

Autonomic - 3.6
Neuroglycopenic - 2.7

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2
Q

False hypoglycaemia

A

Pts w consistently high glucose experience hypo symptoms at higher level than someone with good glycaemic control

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3
Q

Causes of hypoglycaemia in diabetics

A

Carbohydrate - insulin/sulfonylurea therapy
Exercise
Alcohol
Vomiting
Breastfeeding
Other medical problems

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4
Q

Medical problems that can cause hypoglycaemia in diabetics

A

Liver disease
Renal impairment
Hypoadrenalism
Hypothyroidism
Hypopituitarism
Insulinoma

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5
Q

Why is insulin dose often decreased in diabetics with progressive renal impairment

A

Kidneys not clearing insulin so more insulin available - can cause hypo

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6
Q

Autonomic symtoms of hypoglycaemia

A

Sweating
Shaking/tremor
Anxiety
Palpitations
Hunger
Nausea

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7
Q

Neuroglycopenic symptoms of hypoglycaemia

A

Confusion
Slurred speech
Visual disturbances
Drowsiness
Aggression

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8
Q

Hypoglycaemia unawareness

A

Loss of early warning signs of hypo
Often skip past autonomic signs straight to neuro signs

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9
Q

Causes of hypoglycaemia unawareness

A

Incr diabetes duration
Very tight glycaemic control
Autonomic neuropathy

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10
Q

How can hypoglycaemia unawareness be reversed

A

Hypo holiday

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11
Q

Hypo holiday

A

Strict hypo avoidance by relaxing glycaemic control using insulin analogies of an insulin pump to reverse hypo unawareness

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12
Q

Mild moderate and severe hypoglycaemia treatment

A

Mild - sugary drink / 5-7 glucose tablets / 3-4 tsp sugar in water
Moderate - 1-2 tubes glycogel bucally / jam honey treacle into cheek / IM glucagon
Severe - recovery position + 0.5-1mg IM glucagon / 75ml 20% IV glucose over 15mins / 150ml 10% glucose over 15 mins

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13
Q

How to tell between mild moderate and severe hypoglycaemia

A

Mild - conscious and Lucid
Mod - conscious but cannot self administer
Severe - unconscious

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14
Q

Risk of administering 50mls 50% IV glucose for severe diabetic hypo

A

Extravasion can cause chemical burns

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15
Q

What must be given post diabetic hypo once glucose 4+

A

Longer acting carb

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16
Q

When could the driving licence of a diabetic pt be revoked

A

Severe hypo requiring third party assisstance

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17
Q

Signs of nocturnal hypo in diabetics

A

Waking with Rebound hyperglycaemia

Headache/hangover feeling

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18
Q

Nocturnal hypo diagnosis and treatment

A

Glucose test during night or Continuous Glouces monitoring sensor
Analogue insulins, pre bed snack, change insulin time, insulin pump

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19
Q

DKA

A

State of absolute or relative insulin deficiency resulting in hyperglycaemia and an accumulation of ketoacidosis in the blood w subsequent metabolic acidosis

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20
Q

What blood glucose, pH, bicarbonate, serum ketones and urine ketones are usually seen in DKA

A

Glucose 14+
pH <7?3
Bicarbonate <15
Plasma ketones ~ >3
Urine ketones ~ >2\3

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21
Q

Which 2 substances are unbalanced in DKA pathogenesis

A

Excess Catecholamines
Insulin deficiency

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22
Q

How does catecholamine excess contribute to DKA

A

Promote triglyceride breakdown
Stim Gluconeogenesis

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23
Q

Which ketones accumulate in the body in DKA

A

3 OH butyric acid
Acetoacetic acid

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24
Q

What causes ketosis in DKA

A

FFA metabolism due to insulin deficiency

25
Q

What terminates DKA instantly

A

Insulin

26
Q

DKA clinical features

A

Abdo pain
Vomiting
Kussmauls respiration
Ketones on breath
Drowsiness
Confusion
Dehydration
Tachycardia

27
Q

Causes of DKA

A

Insulin omission
Infection
Pregnancy
MI
Alcohol/drugs
Unknown

28
Q

DKA diagnosis

A

VBG showing acidoses
CBG
Often raised urea and creatinine
Elevated urine/plasma ketones

29
Q

What types of ketosis may present with blood glucose below 14

A

Euglycaemic ketosis
Alcoholic ketosis

30
Q

Investigations after DKA

A

Pregnancy test
ECG
CXR
MSU/ blood cultures
Biochemical profile
Lab glucose
FBC
HbA1c

31
Q

What test results indicate greater DKA severity

A

Blood ketones 6+
Bicarbonate <5
pH <7.1
K+ <3.5
GCS <12
O2 says <92%
Sys BP <90
Pulse <60 / >100

32
Q

Potential DKA supportive management and monitoring

A

Level 2 bed
Cardiac monitor
NG tube
Central venous pressure line
Oxygen
Urinary catheter
Prophylactic LMW heparin
IV antibiotic
Monitoring of consciousness BP pulse temp glucose urine output K+ acidosis

33
Q

Fluid therapy regimen for DKA

A

0.9% NaCl
1L stat
1L in 1hr
1L + 20mmpl KCl over 2 hrs
1L + KCl over 4 hrs
1L + KCl over 4 hrs

34
Q

Why is K+ not given in 1st 2L of IV fluid administered to DKA pts

A

Given too rapidly

35
Q

When should IV glucose be given in DKA treatment

A

125ml/hr 5/10% glucose When CBG <12
Incr infusion rate of glucose <6

36
Q

Components for DKA treatment

A

Insulin
0.9% NaCl fluid
Potassium
5/10% glucose

37
Q

Why is insulin administration delayed in DKA pts w K+ <3.5

A

Insulin will further decr k+

38
Q

How should insulin be given in DKA treatment

A

Continue long acting insulin on admission
Start insulin infusion of 50u actrapid made up to 50ml in 0.9% NaCl by IV syringe pump
Fixed rate insulin infusion 0.1u/kg

39
Q

Bicarbonate and glucose changes aimed for during insulin therapy for DKA

A

Bicarbonate 3mmol/hr incr
Glucose 3mmol/hr incr
Incr insulin by 1u/hr if not achieved

40
Q

Common3st cause of death from DKA in children

A

Cerebral oedema

41
Q

Cerebral oedema treatment

A

Dexamethasone or mannitol

42
Q

When does DKA pt return to normal sc insulin

A

Once eating and drinking reliably

43
Q

Why are DKA pts often nauseous after DKA has subsided

A

Ketones not fully cleared

44
Q

Is HHS more common in T1 or T2D

A

T2D

45
Q

Glucose and osmolality levels normally seen in HHS

A

Glucose 40+
Osmolality 340+

46
Q

Is HHS pt often hypernatraemic or hyponatremic

A

Hyper

47
Q

Is ketonuria a component of HHS

A

Sometimes
More likely if not eating due to starvation ketosis

48
Q

What type of acidosis can occur in HHS

A

Lactic acidosis
NOT ketoacidosis

49
Q

Components of HHS

A

Hyperglycaemia
High osmolality
Severe dehydration
Possibly hypernatremic, lactic acidosis, ketonuria

50
Q

HHS treatment

A

IV Fluid
IV insulin ~1u/hr
Possible LMW heparin to decr thrombosis
Possible central venous pressure monitoring

51
Q

Is insulin dose higher in DKA or HHS treatment

A

DKA

52
Q

Major risk of rapid glucose shift in HHS

A

Central pontine myelinolysis

53
Q

Difference between DKA and HHS treatment

A

DKA - higher dose insulin given immediately
HHS - much lower dose and not given for 1st 12 hrs

54
Q

Which electrolyte often declines rapidly in HHS

A

K+

55
Q

Max rate of glucose correction in HHS treatment

A

2mmol/L/hr

56
Q

Diabetic sick day rules

A

Drink fluids
Drink sugary fluids if unable to eat
Monitor glucose more regularly
Never stop tablets/insulin
Insulin dose may need to be incr due to stress on body
Pts on oral agents may need transferring to insulin
Attend hospital if unable to keep fluids down

57
Q

What should a diabetic pt do if they are unable to eat or drink

A

Unable to eat - sugary drinks
Unable to drink - hospital

58
Q

3 most life saving measures in diabetic emergencies

A

Fluid balance
Insulin
Potassium supplementation

Endocrinology, Nephrology, Urology, And Breast Surgery (4 decks)

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