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IM > W1L5 DKA & HHS > Flashcards

W1L5 DKA & HHS Flashcards

1
Q

Who gets DKA?

A
  • Hallmark type 1 diabetes
  • Previous undiag DM(25 – 30%)
  • Interruption to normal insulin regime
  • Intercurrent illness-usually infection
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2
Q

Diabetic Ketoacidosis:Pathophysiology

A
  • N gluc in blood
  • N Mecha
    1. Insulin deficiency
  • lack gluc in ms
    2. glucagon excess
  • increase gluconeogenesis
    3. Rapid lipolysis(free fatty acids & ketone bodies)
    4. Hypovolaemia–vomit+osmotic diuresis
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3
Q

Pathophysiology DKA detailed

A
  • bl. gluc increase=hyperglycemia & glucosuria(water &Na loss)
  • xinsulin=use fat=ketosis
  • > ketone=metabolic acid=lactic acid by dehydration
  • vomit(ileus)=worse dehy
  • electrolyte abnor
  • acidis=k ion enter circu=hyperkalemia
  • phosphate deplete due meta aci
  • dehy=
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4
Q

Precipitating Factors DKA

A
  • New onset type 1 DM(25%)
  • Infections(mos com coz)(40% )
  • Drugs:Steroids, Thiazides, Dobutamine
  • Omission Insulin(20%) due:
  • Non-avail(poor country)
  • fear ohypoglycemia
  • rebel authority
  • fear weight gain
  • stress chronic disease
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5
Q

Symptoms and signs DKA

A
  • Nausea
  • Vomit
  • Abd pain
  • polyuria, polydipsia, weight loss
  • Drowsiness/confusion/coma (severe)
  • Kussmaul respiration - hyperventilation
  • Sign asso sys ill(MI, infection, etc)
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6
Q

DIAGNOSIS DKA

A 
Suspect:
-Dehydration
-Acidotic(Kussmaul’s)breathing w fruity
smell (acetone)
-Abd pain &\ distension
-Vomit
-Alter mental stat(disorientation to coma)

Diagnose:

  1. Hyperglycemia >300 mg/dl & glucosuria
  2. Ketonemia & ketonuria
  3. Metabolic acidosis= pH <7.2
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7
Q

Replacing fluids

A

Initial management:
-1L .9 Nacl(1/2, 1, 2, 4H)
Later(bl gluc <250mmol/L):
-10% dextrose w .9% N saline(125ml/h)

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8
Q

Insulin infusion

A
  • 50U short act reg 50ml NaCl .9%
  • Rate(0.1 unit/kg/hour) 70kg= 7U/h
  • Aim serum HCO3(3 mmol/hr)/7.3 &/ HCO3>18
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9
Q

Replace electrolytes

A
  • K+(mos imp)
  • Insulin shift K+ into cell=rehydrate
  • Serum K ≥ 5.5
    • No potassium supplement
  • Serum K 3.5-5.4
  • Add 20mmol/l
  • Serum K+ <3.5
    • Add 40mmol/l
  • Hyponatraemia due osmotic effect gluc= correct w ttt DKA
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10
Q

Monitoring

A
  • Monitor uo & vital signs closely
    • catheterize
  • Repeat glucose, venous bicarbonate(ABG)
  • 2–4h, 6-8h, 12h, 24h
  • Repeat ABG at 2 hours if ximprove
  • Alternative cause acidis(lactate)
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11
Q

Pitfalls in DKA

A
  • High WCC (xinf)
  • BUN(up w prerenal azotemia 2ry to dehydration)
  • Cr(cross-react w ketone bod=xrenal fx)
  • S Amylase=slh diag pancis
  • Don’t stop insulin even bl gluc N
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12
Q

Complications DKA

A
  • Cerebral Edema
  • Intracranial thrombosis/infarction
  • Acute tubular necrosis
  • peripheral edema
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13
Q

HONK: Hyperosmolar hyperglycaemic state (HHS)

A
  • Hallmark type 2 DM
  • May occur:
    • New diagnosis
    • Poor compy w treatment
    • Intercurrent illness (MI, Inf, CVA)
    • Drugs(Steroids)
    • Sugary drinks
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14
Q

Clinical Presentation HONK

A
  • Possible osmotic symp
  • Dehy 10L deficit
  • Decreased lvl conci
  • Sign inf up to 50%
  • +/- thrombo-embolism up to 30%
  • 2/3 undiagnosed
  • 50% mortality
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15
Q

Diag HONK

A
  • Bl gluc >600mg/dl
  • Absence ketones
  • Serum osmolality >350mmol
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16
Q

How do you calculate osmolality?

A

2(Na+K) + urea + glucose/18

17
Q

Ttt HONK

A

1L 0.9% NaCl(1h, 2h, 4h, 8h)

Insulin:

  • 50U actrapid 50ml w NaCl 0.9%
  • Stop when recover(insulin sensitive)
18
Q

Hypoglycaemia def

A
  • Low plasma gluc conc that potential harm

- Plasma gluc alert value <70 mg/dL (<3.9 mmol/L), w/wo symp

19
Q

Classification of Hypoglycemia ( ADA 2020)

A

Lvl 1= <=70mg/dl(3.9mmol/l)
Lvl 2= <54mg/dl(3.0mmol/l)
Lvl 3= no specific gluc threshold

20
Q

Symptoms of hypoglycemia

A

Autonomic
-Trembling, palpitations, Sweat, Anxiety, Hunger, Nausea, Tingling

Neuroglycopenic
-Bad conc, Confusion, Weak, Drowsy, Vision change, Difi speak, Headache, Dizzy,
Tired

21
Q

Risk factors for hypoglycaemia

A
  • Insulin & sulfonylureas
  • Old people
  • Long duration diabetes
  • Irregular eating habits
  • Exercise
  • Low HbA1c
  • Fasting
  • Hypoglycemia unawareness
  • Alcohol
22
Q

Hypoglycemia - Treatment

A

Mild-moderate:

  • oral ingest 15g carb(gluc/suc tablet/solution)
  • Wait 15min, retest BG & repeat if <70 mg/dl
  • > 70 mg/dl snack is allowed

Severe:

  • Comu: 1mg glucagon im & long act carb on recovery
  • Hospital:
    • I.M. glucagon 1mg
    • I.V. 20ml of 50% dextrose

IM (17 decks)

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