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Diabetic Emergencies

Diabetic Emergencies. Diabetic Ketoacidosis. Type 1 DM +ve ketones + art. pH < 7.30 + bicarb. - < 15 MEDICAL EMERGENCY. Pathogenesis. Insulin deficiency  excess breakdown adipose stores  Inc. fatty acids  oxidised 

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Diabetic Emergencies

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  1. DiabeticEmergencies

  2. Diabetic Ketoacidosis • Type 1 DM • +ve ketones + art. pH < 7.30 + bicarb. - <15 MEDICAL EMERGENCY

  3. Pathogenesis Insulin deficiency  excess breakdown adipose stores  Inc. fatty acids  oxidised  ketone bodies (rate of production>rate of degradation)

  4. Precipitating factors • Acute infection • Poor control • Prepubertal girls – monthly intervals • Failure of compliance

  5. Epidemiology Commonest causes of DKA…. • Infections (30%) • Non-compliance with treatment (20%) • Newly diagnosed diabetes (25%)

  6. GP Investigations • BM + serum glucose • Urine dipstick - ?ketones • Bloods – Na+ (low usually) K+ (high on blood test, total body K+ invariably low) Urea (raised)

  7. Clinical features • Acute onset Vomiting Abdominal pain Headache Thirst Polyuria Hyperventilation Drowsy/coma

  8. Clinical features cont… • Gradual onset Nocturia (nocturnal enuresis in children) Weight loss Lethargy

  9. Clinical features cont… Severly ill – can be in shock, oliguric/anuric NOTE – Breath may smell of ketones

  10. Detecting dehydration in children Useful indicators – • Capillary refill time • Abnormal skin turgor • Respiratory pattern (Kussmaul breathing – deep sighing)

  11. Management in GP • Make diagnosis • Fluid replacement (if poss.) • Oxygen • Consider NG (to stop aspiration/gastric dilatation) • Insulin (give 10u iv whilst pump is being set up)

  12. Prognosis MORTALITY – Developed countries – 2-5% Developing countries – 6-24% Under 28 years old – susceptible to cerebral oedema during treatment (0.7-1.0%)

  13. HONK (Hyperosmolar non-ketotic hyperglycaemia)

  14. DIAGNOSIS • Very HIGH blood glucose - > 30mmol/l • Only trace/1+ ketones in urine • Very HIGH plasma Osmolarity 2(Na + K) + Urea + Glucose

  15. Accounts for 10-15% diabetic decompensation NOTE – serum Na+ may be low – due to redistribution of fluid into the extracellular fluid (secondary to high glucose level)

  16. Precipitating Factors • Infection • High Carbohydrate intake • Thiazide diuretics • Steriods • Propranolol

  17. Clinical Features Consider HONK in… • ELDERLY • Hyglycaemia • Dehydration with excessive thirst • Marked drowsiness

  18. Clinical features cont… Other features… • Convulsions • Coma • Focal CNS signs HONK predisposes to thrombosis Hyperventilation is NOT a feature of HONK

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