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Flashcards in Endocrine Emergencies Deck (57)
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1

Pathophysiology of DKA

Body's response to cellular starvation
Relative insulin deficiency
Counterregulatory excess (glucagon)

2

Why does one become acidotic in DKA?

Relative insulin deficiency
Cellular starvation
Lipolysis with subsequent fatty acid transport to hepatocytes
Formation of ketoacids
Ketonuria
Anion gap metabolic acidosis with capensatory tachypnea
Vomiting

3

Why does one become dehydrated in DKA?

Relative insulin deficiency
Hyperglycemia increases osmotic load and leads to glycosuria
Water drawn out of cells via oncotic pressure
Impaired consciousness
Shock

4

Presentation of DKA

Hyperglycemia
Acidosis from ketoacids
Volume loss

5

Presentation of Hyperglycemia

Polydipsia
Polyuria

6

Presentation of Acidosis from Ketoacids

Tachypnea
Fruity odor of breath

7

Signs of Dehydration

Dry membranes
Poor skin turgor
Delayed capillary refill
Mental confusion

8

Management of DKA

Aggressive fluid therapy (NS)
Place monitor
2 large bore IVs
Bedside glucose, urine dipstick, EKG
CBC, CMP, phosphate, and magnesium
ABGs
Blood cultures/other labs as indicated

9

Fundamentals of Treatment of DKA

Volume repletion
Reversal of metabolic consequences of insulin insufficiency
Correction of electrolyte and acid-base imbalances
Treatment of precipitating cause
Avoid complications

10

Why does fluid administration help with a decrease in blood glucose and ketone concentration?

Increases GFR
Allows for glucose and ketones to be excreted

11

Insulin Therapy in DKA

0.1 units/kg/hr after fluid bolus
Use infusion pump for less complications, flexibility in adjusting dose
AVOID IM and subQ doses

12

What is the most life-threatening electrolyte derangement during treatment of DKA?

Hypokalemia

13

Goals of Potassium Therapy in DKA

Maintain normal extracellular K during acute phase
Replace intracellular K over several days

14

Hypokalemia in DKA due to Therapy

Cardiac arrhythmias
Respiratory paralysis
Paralytic ileus
Rhabdomyolysis

15

Complications of DKA

Hypoglycemia
Cerebral edema
Hypokalemia
Hypophosphatemia
Adult respiratory distress syndrome

16

Reasons for DKA in NOT a New Onset Diabetic

Compliance issues
Discontinuation of insulin
Insults to the body such as infection, MI, PE

17

What condition occurs in patients with poorly controlled or undiagnosed type II DM?

Hyperosmolar hyperglycemic state

18

Define Hyperosmolar Hyperglycemic State

Serum glucose: 600+ mg/dL
Plasma osmolality: 315+ mOsm/kg
Bicarbonate: 15+
Arterial pH: 7.3+
Serum ketones negative

19

Shared Symptoms of DKA and Hyperosmolar Hyperglycemic State

Hyperglycemia
Hyperosmolality
Severe volume depletion
Electrolyte imbalances
Acidosis??

20

Mortality Rates in DKA and Hyperosmolar Hyperglycemic State

DKA: 5%
HHS: 15-30%

21

Risk Factors of Hyperosmolar Hyperglycemic State

Inability to access water
Non-ambulatory patients

22

Presentation of Hyperosmolar Hyperglycemic State

Elderly
Abnormalities in vitals or mental status
Precipitated by acute illness
+/- baseline cognitive impairment
Weakness
Anorexia
Fatigue
Cough
Dyspnea
Abdominal pain

23

Treatment of Hyperosmolar Hyperglycemic State

Volume repletion
Correction of electrolyte abnormalities
Treat precipitating cause
Correction of hyperglycemia
Judicious management of concurrent illness

24

Neurogenic (Increased ANS Activity) Hypoglycemia Signs and Symptoms

Sweating
Pallor
Tachycardia
Palpitations
Tremor/shaking
Nervousness/anxiety
Tingling, paresthesias

25

Neuroglycopenic (Lack of Sugar to Brain) Hypoglycemia Signs and Symptoms

Headache
Drowsiness
Lightheadedness or syncope
Mental dullness or confusion
Amnesia
Seizure
Coma

26

At what glucose level do neurogenic symptoms appear?

Approximately less than 54 mg/dL

27

At what glucose level do neuroglycopenic symptoms appear?

Approximately less than 47 mg/dL

28

Define Hypoglycemia Unawareness

Development of low serum sugar values without physiologic ability to react

29

Patients at Greatest Risk for Hypoglycemia Unawareness

Extremes of age
Co-morbidities
Medications

30

Outpatient Recommendations for Treatment of Hypoglycemia

15-20 g of glucose
Retest glucose in 15 minutes
Prescribed glucagon
Alter insulin or dosage adjustment of oral medication