Diabetic Emergencies Flashcards Preview

2MB Endocrinology > Diabetic Emergencies > Flashcards

Flashcards in Diabetic Emergencies Deck (22)
Loading flashcards...
1

List the main diabetic emergencies

Diabetic ketoacidosis
Hyperglycaemic hyperosmolar syndrome (HHS)
Lactic acidosis
Alcoholic ketoacidosis
Hyperglycaemia

2

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)

3

How do excess ketones form as a result of insulin deficiency?

Increased lipolysis causes increased free fatty acid in the liver, producing more ketones

4

How does hyperglycaemia result from insulin deficiency?

Less glucose utilisation by muscle tissues
Increased proteolysis
Increased glycogenolysis

5

Is DKA more common in type 1 or type 2 diabetes?

Type 1 diabetes

6

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

7

What is the most common precipitant of DKA?

Non-compliance with insulin therapy

8

List symptoms of DKA

Thirst
Polyuria
Vomiting
Abdo pain
Breathlessness (Kussmaul)
Acetone breath

9

What is the blood measurement of ketone?

Beta-hydroxybutarate

10

What is the urine measurement of ketone?

Acetoacetate

11

List some electrolytes that can be lost in DKA

Sodium
Potassium
Phosphate
Also N.B. fluid!

12

List the main complications of DKA

Hypokalaemia
ARDS
Cerebral oedema (esp. in kids)
Aspiration

13

Outline main initial treatment of DKA

Fluids
Potassium
Insulin
Address risk (aspiration, thromboembolism, sepsis)

14

Why might ketonuria persist even after clinical improvement of DKA?

Mobilisation of ketone stores from fat

15

List the typical features of hyperglycaemic hyperosmolar syndrome (HHS)

High glucose
Renal impairment
Raised osmolality
Less ketonaemic

16

How do you calculate osmolality? What is normal range?

(2 x [Na + K]) + urea + glucose
Normal = 285-295

17

Glucose 53.8
Urea 28.3
Na+ 145
K+ 5.6
Calculate osmolality

383.3

18

DKA and HHS tend to occur in younger diabetics. True/False?

False
DKA in younger, HHS in older

19

HHS is more commonly associated with type 1 or type 2 diabetes?

Type 2 diabetes

20

How does treatment in HHS differ from DKA?

More slow and cautious; often just diet-related
May not require insulin
Vascular events more likely

21

What is the normal range of lactate?

0.6-1.2 mmol/L

22

What is the normal anion gap?

10-18 mmol/L