Diabetic Emergencies and Altered Mental Status Flashcards
(55 cards)
Mental Status Regulation
• Regulated by neurologic circuits in brain
that comprise reticular activating system
(RAS)
• RAS responsible for functions of staying
awake, paying attention, and sleeping
• RAS keeps person alert and oriented
Requirements to Maintain Mental Status
- Oxygen to perfuse brain tissue
- Glucose to nourish brain tissue
- Water to keep brain tissue hydrated
Causes of Altered Mental Status
• Deficiences in oxygen, glucose, water to brain tissue • Trauma, infection, chemical toxins harming brain tissue • Primary brain problem (stroke) • Problem within another system (hypoxia due to asthma)
Often altered mental status is rapidly correctable by treating the underlying cause.
Safety
• Patient with altered mental status can be dangerous to responders • Always consider safety of yourself and your team before approaching a patient • Use law enforcement when necessary
Primary Assessment
• Identify and treat life-threatening problems
• Consider oxygen administration
• Be alert to the need for positioning and
suctioning if patient requires it or if mental
status worsens
Secondary Assessment
• Body systems exam and complete history
may reveal information about the
suspected cause of altered mental status
• Interview family members and bystanders
to obtain patient’s baseline mental status
• Family may provide information patient is
unable to give
difference between hypo and hyperglycemia
brain needs oxygen, glucose and water to brain tissue
diabetes mellitus
• Two types • Type 1 – Underproduction of insulin by pancreas • Type 2 – Inability of body’s cells to use insulin properly
Glucose
• Form of sugar
• Body’s basic source of energy
• Body cells require glucose to remain alive
and create energy
Glucose and the
Digestive System
- Glucose molecule is large
* Will not pass into cell without insulin
no insulin, no enzyme - no glucose gets in and the cell uses fat and protein to produce energy - this produces ketone acids
Lock and key mechanism
Insulin
• Produced by pancreas
• Binds to receptor sites on cells
• Allows large glucose molecule to pass into
cells
• Sugar intake–insulin production balance
allows body to use glucose effectively as
energy source
Type 1 Diabetes
• Pancreatic cells do not function properly
• Insulin not secreted normally
• Not enough insulin to transfer circulating
glucose into cells
• Synthetic insulin typically prescribed to
supplement inadequate natural insulin
Type 2 Diabetes
• Body’s cells fail to utilize insulin properly
• Pancreas is secreting enough insulin, but
body is unable to use it to move glucose
into cells
• Condition often controlled through diet
and/or oral antidiabetic medications
Diabetic Emergencies
- Hypoglycemia (low blood sugar)
* Hyperglycemia (high blood sugar)
Hypoglycemia: Causes
- Diabetic takes too much insulin
- Diabetic does not eat
- Diabetic overexercises or overexerts
- Diabetic vomits
- Very rapid onset
- May present with abnormal behavior mimicking drunken stupor
- Pale, sweaty skin
- Tachycardia
- Seizures
- altered mental status
- Starvation of brain cells
- Altered mental status
- Unconsciousness
- Permanent brain damage
normal blood sugar
80-120 mg/dl
hypoglycemia
insulin shock
take too much insulin too much sugar goes into the cells and there is not enough glucose for the brain which can absorb glucose without insulin
rapid onset
cool skin
hyperglycemia
diabetic coma - too much sugar slow onset altered mental status polyuria polydypsia ketones kussmal resp dehydration acetone breath - sweet smelling fruity breath blood pressure 90/60 because of hypovolemic
hyperglycemia causes
• Decrease in insulin – May be due to body’s inability to produce insulin – May exist because insulin injections not given in sufficient quantity • Infection • Stress • Increasing dietary intake
Hyperglycemia: Signs
- Develops over days or weeks
- Chronic thirst and hunger
- Increased urination
- Nausea
Hyperglycemia: Results
• Profound dehydration
• Excessive waste products released into
system
• Diabetic ketoacidosis (DKA)
Diabetic Ketoacidosis: Signs and Symptoms
- Profoundly altered mental status
- Shock (caused by dehydration)
- Rapid breathing
- Acetone odor on breath
insulin shock (hypoglycemic)
rapid onset mimic druken stupor pale sweaty tachycardia seizures
