diabetic emergencies

Question 1

what is diabotic ketoacidosis?

Answer 1

is a disordered metabolic state that usually occurs in the context of an absolute or relative insulin deficiency accompanied by an increase in the counter-regulatory hormones i.e. glucagon, adrenaline, cortisol and growth hormone.

Question 2

who does DKA usually occur in?

Answer 2

younger type 1 diabetics

Question 3

what would the biochemical markers have to be for diabetic ketoacidosis?

Answer 3

• ketonaemia> 3mmol/L
• blood glucose> 11.0mmol/L
• bicarbonate<15mmol/L or venous pH<7.3

Question 4

what are symptoms of DKA?

Answer 4

• thirst + polyuria
• dehydration
• flushed
• vomiting
• abdominal pain and tenderness
• brethlessness

Question 5

what are complications of DKA?

Answer 5

• cardiac arrest secondary to hypokalaemia
• adult respiratory distress syndrome
• cerebral oedema
• gastric dilatation

Question 6

management for DKA?

Answer 6

manage in ICU

• replace losses
• fluid (initially 0.9% sodium chloride and when glucose switches to about 15 switch to dextrose)
• insulin
• potasium
• phosphate (rarely) and bicarbonate (almost never) replaces
• monitor potassium levels
• prescribe LMWH
• source sepsis: CXR, blood culture

Question 7

what is the biochemical diagnosis for HHS? (hyperosmolar hyperglycaemic state)

Answer 7

• hypovolaemia
• marked hyperglycaemia (>30mmol/L)
• no/mild ketonaemia (<3 mmol/L)
• bicarbonate > 15mmol/L or venous pH> 7.3
• osmolality> 320 mosmol/kg

Question 8

who does HHS usually occur in?

Answer 8

• older patients
• young afro caribbean
• type 2 diabetics

Question 9

what is the glucose level in HHS like compared to DKA?

Answer 9

higher glucose level in HHS than in DKA (usually >50mmol/L)

Question 10

what usually causes DKA?

Answer 10

insulin deficiency

Question 11

what usually causes HHS?

Answer 11

• diuretics
• steroids
• fizzy drinks

Question 12

what type of lactic acidosis is associated with tissue hypoxaemia?

Answer 12

type A

Question 13

what type of shocks is type A lactic acidosis associate with?

Answer 13

• cardiogenic shock
• hypovolaemic shock
• endotoxic shock (sepsis)

Question 14

what is type A lactic acidosis associated with?

Answer 14

Tissue hypoxaemia

• infarcted tissue
• cardiogenic shock
• hypovolaemic shock
• sepsis (endotoxic shock)
• haemorrhage

Question 15

what diseases may cause type B lactic acidosis?

Answer 15

• liver disease
• leukaemic states
• diabetes

Question 16

what is the treatment for lactic acidosis?

Answer 16

• treat the underlying condition
• fluids
• antibiotics

Question 17

how may lactic acidosis present?

Answer 17

• hyperventilation
• mental confusion
• stupor or coma if severe

Question 18

what are lab findings for lactic acidosis?

Answer 18

• reduced bicarbonate
• raised anion gap
• glucose is variable (often it is raised)
• absence of ketonaemia
• raised phosphate

Question 19

how do you calculate the anion gap?

Answer 19

[(Na+ + K+) - (HCO3 + Cl-)]