Flashcards in Diabetic Emergencies Deck (22)
List the main diabetic emergencies
Hyperglycaemic hyperosmolar syndrome (HHS)
What is diabetic ketoacidosis (DKA)?
Metabolic state that occurs in the context of insulin deficiency, resulting in increase of counter-regulatory hormones (glucagon, adrenaline, cortisol)
How do excess ketones form as a result of insulin deficiency?
Increased lipolysis causes increased free fatty acid in the liver, producing more ketones
How does hyperglycaemia result from insulin deficiency?
Less glucose utilisation by muscle tissues
Is DKA more common in type 1 or type 2 diabetes?
Type 1 diabetes
Outline the biochemical diagnosis of DKA
Ketonaemia greater than 3mmol/L
Glucose greater than 11mmol/L
Bicarbonate less than 15mmol/L or pH less than 7.3
What is the most common precipitant of DKA?
Non-compliance with insulin therapy
List symptoms of DKA
What is the blood measurement of ketone?
What is the urine measurement of ketone?
List some electrolytes that can be lost in DKA
Also N.B. fluid!
List the main complications of DKA
Cerebral oedema (esp. in kids)
Outline main initial treatment of DKA
Address risk (aspiration, thromboembolism, sepsis)
Why might ketonuria persist even after clinical improvement of DKA?
Mobilisation of ketone stores from fat
List the typical features of hyperglycaemic hyperosmolar syndrome (HHS)
How do you calculate osmolality? What is normal range?
(2 x [Na + K]) + urea + glucose
Normal = 285-295
DKA and HHS tend to occur in younger diabetics. True/False?
DKA in younger, HHS in older
HHS is more commonly associated with type 1 or type 2 diabetes?
Type 2 diabetes
How does treatment in HHS differ from DKA?
More slow and cautious; often just diet-related
May not require insulin
Vascular events more likely
What is the normal range of lactate?