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2MB Endocrinology COPY > Diabetic Emergencies > Flashcards

Diabetic Emergencies Flashcards

1
Q

List the main diabetic emergencies

A 
Diabetic ketoacidosis
Hyperglycaemic hyperosmolar syndrome (HHS)
Lactic acidosis
Alcoholic ketoacidosis
Hyperglycaemia
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2
Q

What is diabetic ketoacidosis (DKA)?

A

Metabolic state that occurs in the context of insulin deficiency, resulting in increase of counter-regulatory hormones (glucagon, adrenaline, cortisol)

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3
Q

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

A

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

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4
Q

How does hyperglycaemia result from insulin deficiency?

A

Less glucose utilisation by muscle tissues
Increased proteolysis
Increased glycogenolysis

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5
Q

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

A

Type 1 diabetes

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6
Q

Outline the biochemical diagnosis of DKA

A

Ketonaemia greater than 3mmol/L
Glucose greater than 11mmol/L
Bicarbonate less than 15mmol/L or pH less than 7.3

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7
Q

What is the most common precipitant of DKA?

A

Non-compliance with insulin therapy

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8
Q

List symptoms of DKA

A 
Thirst
Polyuria
Vomiting
Abdo pain
Breathlessness (Kussmaul)
Acetone breath
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9
Q

What is the blood measurement of ketone?

A

Beta-hydroxybutarate

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10
Q

What is the urine measurement of ketone?

A

Acetoacetate

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11
Q

List some electrolytes that can be lost in DKA

A

Sodium
Potassium
Phosphate
Also N.B. fluid!

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12
Q

List the main complications of DKA

A

Hypokalaemia
ARDS
Cerebral oedema (esp. in kids)
Aspiration

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13
Q

Outline main initial treatment of DKA

A

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

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14
Q

Why might ketonuria persist even after clinical improvement of DKA?

A

Mobilisation of ketone stores from fat

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15
Q

List the typical features of hyperglycaemic hyperosmolar syndrome (HHS)

A

High glucose
Renal impairment
Raised osmolality
Less ketonaemic

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16
Q

How do you calculate osmolality? What is normal range?

A

(2 x [Na + K]) + urea + glucose

Normal = 285-295

17
Q 
Glucose 53.8
Urea 28.3
Na+ 145
K+ 5.6
Calculate osmolality
A

383.3

18
Q

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

A

False

DKA in younger, HHS in older

19
Q

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

A

Type 2 diabetes

20
Q

How does treatment in HHS differ from DKA?

A

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

21
Q

What is the normal range of lactate?

A

0.6-1.2 mmol/L

22
Q

What is the normal anion gap?

A

10-18 mmol/L

2MB Endocrinology COPY (19 decks)

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