Diabetic emergencies: DKA and Hypoglycaemia

Question 1

Define Diabetic Ketoacidosis

Answer 1

This is a state of uncontrolled catabolism due to deficiency in insulin

Question 2

Describe the pathophysiology of dka

Answer 2

Reduced levels of insulin lead to fat breakdown and the formation of glycerol and free fatty acids. The FFA transported to the liver for gluconeogenesis and are also oxidised to form ketone bodies. These ketones escape in the urine but lead to an osmotic diuresis and falling circulating blood volume

Question 3

What are the triad of dka

Answer 3

1. ) Hyperglycaemia
2. ) Raised plasma ketones
3. ) Metabolic acidosis

Question 4

What are the main signs of DKA that someone presents with

Answer 4

1. ) Kussmal breathing: hyperventilation as their blood is acidic so they try to compensate for this by breathing out as much CO2 as they can
2. ) Dehydration
3. ) Hypotension/tachycardia and coma

Question 5

Describe the main symptoms of DKA

Answer 5

1. ) Polyuria AND polydipsia
2. ) Nausea or vomiting
3. ) Weight loss/weakness

Question 6

How would you diagnose DKA

Answer 6

1. ) Hyperglycaemia
2. ) HCO3- would be less than 15 mmol/l
3. ) Urinary ketones dipsticks: more than 2 ketones
4. ) Blood ketones: more than 3.0
5. ) K+ is high on presentation DESPITE total body K+ deficit

Question 7

Describe the management of DKA

Answer 7

1. ) Rehydration
2. ) Insulin IV: stop DKA worsening by inhibiting FFA
3. ) Replacement: of electrolytes (K+)
   - Treatment must start without delay

Question 8

Complications

Answer 8

1. ) Cerebral oedema: common in children
2. ) Adult respiratory distress syndrome
3. ) Thromboembolism: venous and arterial
4. ) Aspiration pneumonia
5. ) Death

Question 9

Define hypoglycaemia in diabetes

Answer 9

This an acute deprivation of glucose within the brain that to cerebral dysfunction