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Endocrinology > DM Set 2 - Acute complications > Flashcards

DM Set 2 - Acute complications Flashcards

1
Q

<p>Once glucose drops <250 in HHS what should be given?</p>

A

<p>D5W w/ saline (0.45 or 0.9)</p>

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2
Q

How severe is hyperglycemia in an HHS pt?

A

600-2400mg

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3
Q

<p>during DKA TXT if glucose falls below <250 what should be given?</p>

A

<p>5 percent glucose solution</p>

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4
Q

Sick-Day guides - what two labs should be monitored?

A

Urine keytones and blood glucose

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5
Q

What is the 2nd MC for of hyperglycemic coma?

A

HHS

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6
Q

What happens to potassium as acidosis is corrected in DKA?

A

Flows back into the cell causing HYPOkalemia

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7
Q

At what level of glucose does Neuroglycopenic S/S occur?

A

Around 50mg (eventually leads to LOC/Seizures)

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8
Q

What is the target glucose value for DKA and HHS?

A

250-300

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9
Q

What happens when a DKA pt is given sodium Bicarb?

A

Slows hyperventilatory drive causing pCO2 to raise

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10
Q

EKG reading of Peaked T waves indicate

A

HYPERkalemia

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11
Q

Which has a higher mortality rate DKA or HHS?

A

HHS

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12
Q

Best TXT for hypoglycemia is

A

PVT

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13
Q

EKG reading of flat T waves w/ U-waves indicate

A

HYPOkalemia

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14
Q

What 2 P’s are associated with DKA?

A

For 1-2D Polyuria/Polydipsia

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15
Q

If no IV glucose or IM glucagon for severe hypoglycemia give?

A

Honey/syrup/glucose gel into cheek or ass

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16
Q

IV TXT of severe hypoglycemia is?

A

50ml of 50 percent glucose solution

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17
Q

Who does HHS usually effect?

A

Mild or UNDx DM (middle ages/edlerly DM2)

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18
Q

Potassium is lost during DKA due to?

A

Polyuria and vomiting

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19
Q

How much bicarb should be given to TXT DKA?

A

1-2 ampules added into 1L of 0.45 percent saline

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20
Q

Maintaing blood glucose at 250-300 PVTs what in HHS?

A

Cerebral edema and hypoglycemia

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21
Q

What alternative route for maintenance insulin can be given to TXT DKA?

A

IM

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22
Q

What causes HHS to have a worse prognosis?

A

CHF/CKD

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23
Q

<p>Ecessive fluids (>5L in 8hrs) during DKA can cause what?</p>

A

<p>ARDS or Cerebral edema</p>

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24
Q

How much K+ can be given in HHS?

A

KCl of 10mEq added to initial bag

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25
Q

Which acute DM complication would you find HOTN & tachycardia?

A

DKA

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26
Q

When should 0.45 percent saline be used for HHS?

A

NO hypovolemic state

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27
Q

What are the recommended DKA TXT doses of insulin?

A

Load - 0.1U/kg Bolus (Primes insulin recepetors) Main - 0.1U/kg/hr continuous infusion

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28
Q

When should NL saline be used for HHS?

A

Hypovolemic (HOTN+Oliguria)

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29
Q

When should insulin TXT start for a DKA pt?

A

Immediately after IV fluid initiation

30
Q

<p>Important reasons hypoglycemia can occur?</p>

A

<p>Impaired glucagon response (DM >5yrs) CKD Gastroparesis </p>

31
Q

what is the MC patient that develops DKA?

A

DM1 pts - but may occur in DM2 (trauma sepsis)

32
Q

<p>Hypoglycemia occurs around what level?</p>

A

<p><54mg</p>

33
Q

What is the main TXT of DKA?

A

IV fluids Insulin Potassium

34
Q

Does HHS present with Kussmauls?

A

NO

35
Q

What can be added to the main TXT of DKA?

A

Bicarb or ABX PRN

36
Q

How much IV fluids is req for HHS?

A

4-6L over 8-10hrs

37
Q

How does potassium cause acidosis?

A

K+ leave cells into extracellular space

38
Q

Admit/ER TXT of severe hypoglycemia?

A

Adequate AW then IV glucose

39
Q

<p>At what sick-day lab values should you call HCP?</p>

A

<p>POS urine keytone for >6hr >250 blood glucose for >6hr</p>

40
Q

Every pt receiving insulin req?

A

Glucagon kit

41
Q

What insulin should be initially started when TXT DKA?

A

Only Regular insulin

42
Q

<p>If a DKA pt has a <3.5 potassium what should be delayed during TXT?</p>

A

<p>Must delay insulin until potassium is >3.5</p>

43
Q

As tissues don’t uptake glucose the liver begins what?

A

Gluconeogensis

44
Q

In DKA why is there so much fluid/lyte loss?

A

Ketonuria, Osmotic Diuresis and dehydration

45
Q

When DKA is under control what changes to insulin should be made?

A

Change to SQ insulin when pt awake and able to eat

46
Q

Always follow up mild glucose replacement w/?

A

Complex Carbs

47
Q

How often should someone check there sick-day labs?

A

Keytones Q2-4h Bld glucose QID

48
Q

<p>If pt is already hypnatremic >150 Na what fluid should be given for DKA TXT?</p>

A

<p>0.45 percent saline</p>

49
Q

During DKA potassium can be?

A

NL to slightly elevated

50
Q

Which acute DM complication does Kussmauls respiration affect?

A

DKA (rapid deep breathing)

51
Q

What is the goal of Insulin DKA TXT?

A

Correct Acidosis and reduces Osmolality

52
Q

What is absent in HHS?

A

Ketosis, Acidosis, and Kussmauls

53
Q

Pahto-G of HHS

A

Insulin deficit causes reduced utilization thus increasing hepatic glucose output (HYPERglucagonemia)

54
Q

Should initiate K+ when in HHS?

A

Earlier than DKA unless CKD or oliguria

55
Q

How much and when should Postassium be given?

A

During 2-3hr of therapy of 10-30mEq

56
Q

What happens to potassium when Bicarb is given in a DKA pt?

A

K+ shifts into cells causing HYPOkalemia

57
Q

<p>What BUN value can be expected with HHS?</p>

A

<p>>100 (Prerenal azotemia (reduced Bloodflow)</p>

58
Q

Which acute DM complication would you find Fruity breath odor?

A

DKA

59
Q

What is HHS?

A

Severe hyperglycemia in the absence of keytones

60
Q

During sick days what should the pt continously take?

A

Insulin

61
Q

What is the fluid of choice for DKA TXT?

A

0.9 NL saline given 1L/hr over 2hrs then 300-400ml/hr

62
Q

Adding bicarb into NL 0.9 percent saline would cause?

A

Very hypertonic solution

63
Q

Why does HHS have a higher mortality rate?

A

Insidious organ dysfx and delayed DX

64
Q

What dose of insulin should be given in HHS?

A

Initial dose 0.15U/kg then titrate 50-70mg/dL/hr to lower blood glucose

65
Q

If a pt has an insulin pump what shold they regularly test?

A

Urine keytones

66
Q

Why is 0.45 percent saline given with HHS?

A

Avoids contributing to the hyperosmlar state

67
Q

What drugs can precipitate HHS?

A

Thiazide Diuretics and GCC

68
Q

At home TXT of severe hypoglycemia req?

A

Glucagon kit (1mg ampules)

69
Q

If IV glucose is not available for TXT of severe hypoglycemia then give?

A

(IM) 1mg Glucagon

70
Q

<p>When should Bicarb be considered in a DKA pt?</p>

A

<p>ph <7.0</p>

71
Q

DM pt should always carry

A

Glucose tablets/juice (3gm dextrosol)

Endocrinology (5 decks)

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