Pales DM CIS part I Flashcards
What is diabetic ketoacidosis
glucose >250
acidosis with blood pH <15
serum + ketones
When does DKA present in DM II
late stages beta cell failure
during stress
signs DKA
weakness, decreased appetite, nausea, vague abdominal pain
mental status changes: confusion, lethargy, coma
signs of acidosis
confusion, lethargy, kussmal respration
fruity breath
signs of dehydration
oral membranes
turgor of skin
hypotension/tachycardia
DKA labs
high blood glucose low CO2/bicarb/pH high ketones/acetone/ketoacids high BUN Cr high serum K with decrease total body K low Na high PO4
how to correct Na for high glucose
for every 100 over add 1 to Na
Tx DKA
IV insulin to correct acidosis!!!
give glucose too to buffer the insulin because need enough insulin to correct acidosis
labs for hyperosmolar hyperglycemic non-ketotic state
high glucose serum osmolality>310 no acidosis (pH>7.3) serum bicarb>15 normal anion gap <14 low K Na can be low (correct for glucose and then hgih) elevated BUN/Cr
what causes hyperosmolar hyperglycemic non ketotic state
hyperglycemia causes osmotic diuresis causing dehydration increaseing osmolality, decrease free fluid and resulting in hyperglycemia
what can hyperosmolar hyperglycemic nonketotic state lead to
hypovolemic shock
end organ damage: coma, renal failure
what DM can have hyperosmolar hyperglycemic non ketotic state
DM II
non compliance to medications
Tx hyperosmolar hyperglycemic non-ketotic state
IV fluids
a little IV insulin
electrolyte replacement
ventilatory support at times
when can hypoglycemic coma happen
blood glucose <50
2 conditions when can have diabetic coma
DM
or those with metabolic disturbance
hypoglycemia Sx
HA sweat shaky hungry confused grumpy dizzy
Tx hypoglycemic coma
sugar orraly
glucagon SQ
microvascular complicaitons DM
neuropathy: peripheral sensory and motor. also autonomic
nephropathy: chronic kidney disease
retinopathy: blindness
macrovascular complications D
atherosclerosis of big arteries coronary- MI cerebral/carotid-stroke LE- LE amputation Renal-HTN- MI/stroke mesenteric-bowel ischemia
leading cause blindness in US
diabetic retinopathy
2 types retinopathy
- nonproliferative “background”
- proliferative
what is most common retinopathy
non proliferative from microaneurysms, dot hemorrhages, retinal edema
cause of proliferative retinopaty
new capillaries and fibrous tissue in retina from ischemic retinal infarcts (wool spots)
other ocular complications (not retinopathy) form DM
lens swelling (reversible) cataracts
