When do you give bicarbonate in a ketoacidosis?
If the pH <6.8
What are some predisposing factors for the development of DKA?
Inappropriate insulin therapy
Infections - pneumonia
What are the general principles of treatment of DKA?
Treat electrolyte imbalance
Search for underlying cause
Who are particularly susceptible to getting hypo's?
Elderly with renal impairment on sulfonylureas
What must you do before giving insulin in a patient with DKA?
Check the K levels, if <3.5mM hold off
What are the defining features of hyperglycaemic hyperosmolar state?
Limited ketosis or ketoacidosis
Severe osmolarity >330mOsm/kg
Depressed sensorium or coma
What is the treatment for HHS?
Fluid resusitation with hypotonic saline - 2L over 1 to 2 hours
Monitor urine output
Search for cause
What is Kussmaul's breathing?
Deep, laboured breathing that occurs during metabolic acidosis
Why does HHS occur?
Relative lack of insulin > hyperglycaemia > polyuria > volume depletion
How is hypoglycaemia treated?
Oral sugar if tolerable
IV 50% dextrose 25-50ml
IM glucagon 1mg if no IV
Administer longer acting CHO
What is the normal range for potassium?
Which is a bigger determinant of conscious state, osmolarity or acidosis?