Diabetic Emergencies Flashcards
(29 cards)
What is Kussmaul respiration?
Deep ‘sighing’ respirations secondary to metabolic acidosis
What percentage of T1DM patients first present with DKA?
20-25%
Name three precipitants of DKA.
- Infection
- D&V
- MI
Key exam findings in DKA?
- Kussmaul breathing
- Sweet / fruity breath odour
- Tachycardia
- HoTN
- Dry mucous membranes
What is a common abdominal exam finding in DKA?
Absent bowel sounds
Stomach bubble (ketones suppress peristalsis leading to gastroparesis)
What are the three criteria for diagnosing DKA?
- Hyperglycaemia >11
- Ketones >3.0 or ketonuria
- Acidosis pH <7.3 (bicarbonate <15 mmol/L)
What blood tests are commonly performed in DKA?
- FBC
- U&E (Hyperkalaemia (no insulin to drive K+ into cells) + Hypercalcemia (acidosis displaces Ca2+ from albumin))
- LFTs
- CRP (infection is a possible trigger)
- Glucose
- HbA1c
- VBG (ketones)
What is the significance of anion gap in DKA?
High anion gap metabolic acidosis indicates DKA
True or False: DKA is a hypercoagulable state.
True
What is the fluid treatment for DKA?
1L 0.9% NaCl STAT
What is part of DKA treatment protocol?
FIG-PICK
F: Fluids, 1 litre stat then 4 liters w/ added k+ over next 12 hours
I - Insulin: Actrapid .1 unit/kg/hr
G- Glucose: Monitor and add dextrose infusion if belo 14mmol
P - Potassium Monitor 4x hourly
I- Infection: Treat underlying infections
C- Chart fluid ballance
K- Ketones: Monitor blood ketones
What are the targets in DKA management?
■ Reduce ketones by 0.5 mmol/hr
■ Reduce glucose by 3 mmol/hr
■ Increase bicarbonate by 3 mmol/hr
■ Keep K+ in the range of [4.5-5.0]
What is a potential complication of DKA treatment in children?
Cerebral oedema
What to monitor for in DKA?
Long term complications of diabtetes?
Macrovascular: coronary arrtrery dsiease, peripheral ischemia => diabtic foot, stroke
Microvascular: peripheral neruopathy, reitnopathy, kidney dsiease
Infection : UTI, Skin infections
Name two diabetes-specific autoantibodies associated with T1DM.
- Islet cell antibodies
- Insulin autoantibodies
What is the recommended frequency for monitoring neuro observations in DKA treatment?
Every 30 mins until GCS at baseline, then less frequently
What is the mortality rate associated with HHS?
Up to 20%
HHS stands for Hyperglycemic Hyperosmolar State.
What results from hyperglycemia in HHS?
Osmotic diuresis, severe dehydration, and electrolyte deficiencies.
Who typically presents with HHS?
Elderly T2 diabetics.
What are common precipitating factors for HHS?
- Intercurrent illness
- Dementia
- Sedative drugs
What symptoms are associated with HHS?
- Polydipsia & polyuria
- Lethargy
- Nausea & vomiting
How does the chronicity of symptoms differ between DKA and HHS?
DKA presents within hours, whereas HHS develops over many days.
What are the typical investigations used in HHS diagnosis?
- Hypovolaemia
- Marked hyperglycaemia (>30 mmol/L)
- Raised serum osmolarity (>320 mosmol/kg)
- No significant hyperketonemia (<3 mmol/L)
- No significant acidosis (bicarbonate >15 mmol/L or pH >7.3)
