Diabetes Mellitus Fifth Stage-Medicine. Dr. Sarbast Fakhradin MBChB, MSc Diabetes Care & Management. Acute complications of diabetes. 1. Diabetic ketoacidosis 2. Non-ketotic hyperosmolar hyperglycemic coma 3. Hypoglycemia 3. Lactic acidosis. Diabetic ketoacidosis.
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Dr. Sarbast Fakhradin
MBChB, MSc Diabetes Care & Management
Every patient in diabetic ketoacidosis is potassium-depleted, but the plasma concentration of potassium gives very little indication of the total body deficit. Plasma potassium may even be raised initially due to disproportionate loss of water, catabolism of protein and glycogen, and displacement of potassium from the intracellular compartment by H+ ions.
• The magnitude of the hyperglycaemia does not correlate with the severity of the metabolic acidosis
→Pyrexia may not be present initially because of vasodilatation secondary to acidosis.
Poor prognostic sign in DKA at Admission include:
Plasma osmolarity= 2(Na+) + 2(K+) + (Glucose) + (Urea)
The normal value is 280-290 mmol/kg, the conscious level is depressed when it is high (> 340 mmol/kg).
→Start with 0.45% saline until the osmolality approaches normal, then replace by isotonic (0.9%) saline.
• Monitor CVP & plasma sodium frequently.
• Thromboembolic complications are common, prophylactic subcutaneous LMWH is recommended
1.Exogenous drugs (Insulin, SU) & alcohol.
2. Pituitary insufficiency
3. Liver failure & inherited enzyme defect
4. Addison’s disease
5. Islet cell tumors (Insulinoma) & Anti-insulin receptor antibody in hodgkin’s disease)
6. Non-pancreatic neoplasm eg hemangiopericytoma.
If the patient fails to regain consciousness after blood glucose is restored to normal consider: