glucose disorders

Question 1

what is the 3 things that overlap in a patient with DKA (diabetic ketoacidosis)

Answer 1

uncontrolled hyperglycemia
metabolic acidosis
increased ketone concentration

Question 2

hyperglycemia results from what 3 pathophysiological thing

Answer 2

1. increased gluconeogenesis
2. accelerated glycogenolysis
3. impaired glucose utilization

Question 3

what is the most common precipitating factor of hyperglycemic emergencies

Answer 3

infection

Question 4

what 3 electrolyte imbalances are common in DKA?

Answer 4

1. potassium - elevated
2. sodium - false lowering
3. phosphate - decreases with therapy

Question 5

what is the purpose of IV fluids in hyperglycemic emergencies

Answer 5

volume expansion and restoration of renal perfusion

Question 6

what is thought to be the pathogenesis of HHS

Answer 6

insulin is secreted but inadequate to remove glucose from blood

Question 7

what are 4 precipitating factors for hyperglycemic emergency other than an infection

Answer 7

1. noncompliance with insulin
2. new onset DM
3. acute major illness
4. drugs

Question 8

upon physical exam, HHS problems often have what 4 things?

Answer 8

1. dehydration
2. hypotension
3. decreased skin turgor
4. dry mucous membranes

Question 9

what hyperglycemic emergency is characterized by very high glucose levels, often over 600

Answer 9

HHS

Question 10

what are the 3 categories of treatment for hyperglycemic emergency

Answer 10

1. IV fluids
2. Insulin
3. electrolyte management

Question 11

Initial fluid replacement should use what and in hyperglycemic emergency? In what time period should deficits be corrected?

Answer 11

0.9% NaCl

within 24 hours

Question 12

once glucose reaches what levels should fluid be switched from nacl?
what should it be switched to

Answer 12

200 for dka
300 for HHS
switch to D5 + 0.45% NaCl

Question 13

what is the goal of reuced blood glucose in the first hour of insulin treatment

Answer 13

50-70 mg/dL

Question 14

what is the goal BG for DKA with continuous IV insulin treatment?
HHS?

Answer 14

DKA = 150-200
HHS = 200-300

Question 15

when can transition to SQ insulin be initiated for DKA

Answer 15

BG less than 200 
PLUS 2 of the following:
1. bicarbonate greater than 15
2. pH greater than 7.3
3. anion gap less than 12

Question 16

when can transition to SQ insulin be initiated for HHS?

Answer 16

1. normal serum osmolality

2. normal mental status

Question 17

how long of an overlap between discontinuation of insulin infusion and SQ administration should be allowed

Answer 17

1-2 hour overlap

Question 18

what electrolyte abnormality is common in treatment of hyperglycemic emergency? why?

Answer 18

hypokalemia; caused due to insulin moving K into cell.

Question 19

how much potassium should be added to each liter of fluid once serum K is less than 5.2

Answer 19

20-30 mEq of K

Question 20

people with what K concentration should not receive insulin therapy

Answer 20

K less than 3.3

Question 21

when is bicarbonate given in hyperglycemic emergencies?

Answer 21

cases with a pH less than 6.9

Question 22

when is phosphate given in hyperglycemic emergencies?

Answer 22

1. cardiac dysfunction
2. anemia
3. respiratory depression
4. phosphate level less than 1