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Inflammation > Diabetic Emergencies > Flashcards

Diabetic Emergencies Flashcards

1
Q

Hyperglycaemic emergencies

A

DKA= diabetic ketoacidosis

HHS= hyperosmolar hyperglycaemic state

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2
Q

DKA is

A

Complex disordered metabolic state due to absolute or relative insulin deficiency

Occur in type 1 mainly

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3
Q

DKA defines by biochemical triad of

A

Hyperglycaemia
Hyperketonaemia
Metabolic acidosis

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4
Q

DKA diagnostician criteria

A

Blood glucose > 11mmol/l or diabetes

Blood ketones > 3 mmol/l or ketonuria >2+

Bicarbonate < 15 mmol/l and /or venous ph <7.3

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5
Q

Other effects of DKA

A

Dehydration and disordered potassium

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6
Q

DKA pathogenisis route

A

Insulin deficiency > increase production of glucose from liver + less uptake from fat

Increased lipolysis with release of FA

FA partially oxidised to ketone bodies = ketonaemia

Acetoacetate and 3 hydroxybutyrTe

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7
Q

Potassium in DKA problem

A

Insulin causes K+ to move into cells

Insulin deficient means K+ leaks out of cells = high extra cellular K+= hyperkalaemia

Hyperkalaemia= renal loss K+ loss> whole body depletion

When DKA treated K+ moves into cells
Whole body is K+ deplete
Extracellular K+ falls quickly

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8
Q

Severity of DKA

A

DKA is life threatening

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9
Q

Complications of DKA

A

Cerebral oedema
Adult respiratory distress syndrome/ acute lung injury

Pulmonary embolus

Arrhythmia s

Multi organ failure

Co morbid stress

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10
Q

Symptoms of DKA

A

Polyuria,polydipsia, thirst

Weight loss
Blurred vision
Vomiting
Abdominal pain
Weakness
Leg cramps
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11
Q

DKA investigations

A 
Kussmaul respiration
Ketotic factir
Dehydration 
Tachycardia
Hypotension
Mild hypothermia 
Confusion, drowsiness, coma
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12
Q

DKA investigations

A

Near patient (bedside tests)

Capillary blood glucose
Blood ketones
Venous blood gases

Diagnostic criteria

Other investigations 
Glucose /U&amp;E/Fbc
ECG 
CXR
blood culture 
MSU
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13
Q

Aims of treatment for DKA

A

Clear ketonaemia and metabolic acidosis

Avoid complications of DKA and it’s management

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14
Q

Principles of treatment for DKA

A

Fluid replacement
-intravenous saline 0.9%

Insulin replacement
- fixed rate intravenous insulin infusion

Potassium replacement
- serum K high but total body K low

Identify and treat cause

Venous thromboembolism prophylaxis

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15
Q

HHS occurs in

A

Type 2 diabetes

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16
Q

HHS ketones present??

A

Enough insulin to surprise ketogenisis

17
Q

HHS categorised by

A

Hypogolaemia
Marked hyperglycaemia
Hyperosmolarity

18
Q

HHS causes

A

High glucose
Osmotic diuretics
Volume depletion

Thirst

19
Q

HHS severity

A

Life threatening

20
Q

Complications at HHS

A

HHS develops over days and metabolic disturbance is more severe than DKA

Cerebral oedema 
Osmotic demyelination syndrome 
Seizures
Arterial thrombosis,MI,CVA
Venous thrombosis 
Multi organ failure
Foot ulceration
21
Q

Clinical features of HHS

A 
Thirst 
Polyuria
Blurred vision
Weakness
Dehydration
Tachycardia
Hypotension
Confusion and drowsiness
Coma
22
Q

HHSinvestigations

A

Capillary blood glucose
Blood ketones
Urine ketones
Venous blood gases

23
Q

HHS characteristic features

A

Dehydration
Blood glucose >30mmol/l
Blood ketones <3mmol/l or no urine ketones

Osmolality >320mosmol/kg

24
Q

Management of HHS

A

Gradually and safely normalise osmolality of fluid status and glucose

Fluid replacement:
Intravenous 0.9% saline

Insulin replacement
-fixed rate intravenous insulin infusion (lower than DKA 0.05 units/kg/hour)

Identify and treat the cause
Venous thromboembolism prophylaxis

25
Q

Sick day rules for type 1 diabetics

A

Never stop background insulin (even if vomiting)

Check capilllary BG frequently

Check for ketones

Extra short acting insulin

Keep drinking fluid

26
Q

Hypoglycaemia is

A

Low blood glucose

In diabetes defined as < 3.5 mmol/L

Midsymptomatic- person recognises the hypo and able to treat themselves

Severe- defined as an episode in which the person is unable to treat him/herself because of cognitive capacity induced by hypoglycaemia

27
Q

Hypoglycaemia is a side effect of?

A

Treatment

28
Q

Hypoglycaemia is a problem as

A

Brain has no energy
Can’t use alternative energy stores

In diabetes suppressed glucose and ketone production by liver
Glucose diverted to fat and muscle

29
Q

Symptoms of hypoglycaemia

A

Autonomous nervous system
Sweating tremor /palpitations

Drowsiness
Confusion
Visual disturbance

Hunger
Nausea

30
Q

Treatment of mild hypoglycaemia

A

Check glucose then give sugary treat and check blood glucose in 10 mins

31
Q

Treatment of severe hypoglycaemia

A

Unconscious or not able to swallow safely
Calle for help ABCDE
Check cap blood glucose

If conscious do same thing you would do for mild

32
Q

Once recovered from hypo what now

A

Give long lasting complex carbohydrate: 2 biscuits/ slice of bread

Don’t omit not insulin injection

Inflammation (34 decks)

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