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Endocrine Module > Acute Hyperglycemic Control > Flashcards

Acute Hyperglycemic Control Flashcards

(55 cards)

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1
Q

What is the most common cause of DKA/HHS?

A

Infection

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2
Q

What are the 3 reasons why hyperglycemia develops?

A

Increased gluconeogenesis, accelerated glycogenolysis, and impaired glucose utilization

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3
Q

Increased released for free FA and hepatic FA oxidation leads to what?

A

Increased ketone production = ketoacidosis = DKA

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4
Q

What is the main metabolic product of ketones?

A

Beta Hydroxybutyrate

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5
Q

What are the 3 components of ketones?

A

Beta hydroxybutytrate, acetoacetate, and acetone

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6
Q

What are the clinical similarities between DKA and HHS?

A

Hyperglycemia, polyuria, polydipsia, polyphasic, weight loss, N/V, dehydration, poor skin turgor, weakness, mental status changes, tachycardia, and hypotension

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7
Q

What are the clinical presentations specific to DKA?

A

Rapid onset, high ketones, kussmaul respirations, fruity breath odor, and abdominal pain

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8
Q

What are the clinical presentations that are specific to HHS?

A

Onset over several days to weeks, mild or no ketones, seizures

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9
Q

What is the minimum glucose cutoff for DKA?

A

250

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10
Q

What is the arterial pH range for MILD DKA?

A

7.25-7.30

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11
Q

What is the arterial pH range for MODERATE DKA?

A

7.0-7.24

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12
Q

What is the arterial pH range for SEVERE DKA?

A

<7

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13
Q

What is the serum bicarb range for MILD DKA?

A

15-18

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14
Q

What is the serum bicarb range for MODERATE DKA?

A

10-14

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15
Q

What is the serum bicarb range for SEVERE DKA?

A

<10

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16
Q

What is positive in DKA across all stages?

A

Urine and Serum Ketones

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17
Q

What is the anion gap for MILD DKA?

A

> 10

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18
Q

What is the anion gap for MODERATE DKA?

A

> 12

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19
Q

What is the anion gap for SEVERE DKA?

A

> 12

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20
Q

What is the glucose value for HHS?

A

600

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21
Q

What is the arterial pH for HHS?

A

> 7.3

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22
Q

What is the serum bicarb in HHS?

A

> 15

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23
Q

Are ketones found in HHS?

24
Q

What is the serum osmolality in HHS?

Study These Flashcards
A

> 320, dehydrated

25
What must you do with sodium prior to proceeding with treatment therapy options?
Correct it
26
How do you correct sodium?
Blood Glucose - 100 = A A/100 = B B x 1.6 = C C + Current Sodium = Corrected Sodium
27
Is sodium usually high or low in DKA vs HHS?
DKA: LOW HHA: HIGH
28
What is the LOW potassium range?
<3.3
29
What is the HIGH potassium range?
>5.2
30
When is osmolality low?
High amount of water in relation to dissolved particles and you have over hydration
31
When is osmolality high?
Deficient fluid volume and dehydration
32
Do you use corrected sodium in the osmolality equation?
NO
33
What does a larger anion gap mean?
Severe acidosis
34
Do you use corrected sodium in anion gap equation?
NO
35
What is the Sodium IV Fluid Algorithm for DKA?
1. Normal Saline Immediately 2. Correct Sodium 3. Low Sodium = Keep normal saline 4. Normal/High Sodium = stop normal, start half saline 5. Once glucose is 200, change to D5W/half saline
36
What is the Potassium IV Fluid Algorithm for DKA?
1. Low <3.3 = give potassium, HOLD insulin 2. Normal 3.3-5.2 = give potassium and insulin 3. High >5.2 = stop potassium, GIVE insulin
37
What is the Insulin Algorithm for DKA?
1. Start Insulin 0.14 units/kg/hr (ONLY IF POTASSIUM IS OK) 2. If it does not fall 10% continue regimen 3. Glucose = 200 4. Change rate to 0.02-0.05 units/kg/hr 5. OR give 0.1 units/kg SQ every 2hrs
38
What do you do with Insulin upon DKA resolution?
1. Keep glucose 150-200 until DKA resolves 2. Keep IV insulin for 1-2 hrs after starting SQ therapy 3. Restart SQ therapy at patient doses prior to DKA or at 0.5-0.8 units/kg/day 4. Wait until anion gap closes to turn off insulin
39
When should you treat serum bicarb?
<6.9
40
When should you treat serum phosphate?
<1
41
What is the definition of resolution of DKA?
Blood glucose < 200 AND (2 0f 3) 1. Bicarb >15 2. pH >7.3 3. Calculated Anion Gap <12
42
What is the Sodium IV Fluid Algorithm for HHS?
1. Normal Saline Immediately 2. Correct Sodium 3. Low Sodium = Keep normal saline 4. Normal/High Sodium = stop normal, start half saline 5. Once glucose is 300, change to D5W/half saline
43
What is the Potassium IV Fluid Algorithm for HHS?
1. Low <3.3 = give potassium, HOLD insulin 2. Normal 3.3-5.2 = give potassium and insulin 3. High >5.2 = stop potassium, GIVE insulin
44
What is the Insulin Algorithm for HHS?
1. Start Insulin 0.14 units/kg/hr (ONLY IF POTASSIUM IS OK) 2. If it does not fall 10% continue regimen 3. Glucose = 300 4. Change rate to 0.02-0.05 units/kg/hr 5. OR give 0.1 units/kg SQ every 2hrs
45
What do you do with Insulin upon HHS resolution?
1. Keep glucose 200-300 until DKA resolves 2. Keep IV insulin for 1-2 hrs after starting SQ therapy 3. Restart SQ therapy at patient doses prior to DKA or at 0.5-0.8 units/kg/day
46
What is the definition of resolution of HHS?
Blood Glucose <300 AND 1. Normal Osmolality <315 2. Normal mental status
47
What are the 4 acute complications?
Hypoglycemia, Hypokalemia, Hyperglycemia, and Cerebral Edema
48
What causes hypoglycemia?
Agressive insulin
49
What causes Hypokalemia?
Aggressive insulin
50
What causes Hyperglycemia?
Insulin stopped too early
51
What causes Cerebral Edema?
Plasma osmolality decreases too quickly
52
When should you routinely monitor ketones?
BG = >300
53
What does Ketostix measure?
Acetoacetate
54
What does Blood Ketones measure?
Beta-Hydroxybutyrate
55
When should you increase the frequency of SMBG and ketone monitoring to every 2 hours?
Sick Days

Endocrine Module (16 decks)

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