Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Emergency in endocrine
system
Acute Complication of Diabetes
Dr.MMD
3
DKA
Diabetic Ketoacidosis
Precipitating Causes
Pathophysiology of DKA
Ketosis
Dehydration
Electrolyte imbalance
8
Symptoms of DKA
Abdominal pain Polyuria
Anorexia Somnolence
Dehydration Tachycardia
Fuity breath Thirst
Kussmauls Visual disturbances
Change LOC Warm, dry skin
Hypotension Weakness
Wt. loss
11
Assessment DKA
Hyperglycemia
Hyperosmolality
Dehydration
Electrolyte imbalances
Metabolic acidosis
Hypoglycemia
Fluid overload
12
13
Intervention
Rehydrate
Reverse shock
Give Potassium
Corret pH
Give insulin
14
Critical Monitoring
Rehydration
Daily Weight
Skin turgor, LOC, VS
CVP measurement
Auscultation of lungs
15
IV Fluids in DKA
Hour 1
N/S or Ringers lactate (15-20ml/kg)
Hour 2
Continue fluid, consider half-strength NS
Hour 3
Reduce fluid intake to 7.5ml/kg, use half-strength NS
Hour 4
Consider urine output in adjusting fluids
16
After the initial 2 hour the remainder of the fluid deficit is given at
the rate of 1 liter/hour.
17
Look at EKG
Replacement is based on plasma potassium
level
Recheck potassium q 2 hours
18
Give IV Insulin
Give Regular Insulin only
Initial bolus IV (0.15u/kg)
Then Regular Insulin IV drip
19
HHNK
Hyperglycemic Hyperosmolar Noketotic Syndrome
Hyperosmolar Hyperglycemic
State
Extremely high blood glucose level (600-
2000 mg/dL)
Absence of or small amounts of ketones
Profound dehydration
Pts have sufficient insulin to prevent lipolysis
and ketosis
Occurs in older patients with type 2 diabetes
Treatment: hydration and small doses of
insulin to correct the hyperglycemia
21
Glucose BUN
2(Na + K) + + mOsm/liter
18 2,8
Treatment
Similar to DKA
Find underlying cause
23
24
Hypoglycemia
Risk Factors
Overdose of insulin
Omitting a meal
Overexertion
Nausea and vomiting
Alcohol intake
PHYSIOLOGY OF
GLUCOSE COUNTERREGULATION
Characteristic sequence:
1. insulin secretion:
glucose concentrations decline within the physiological range (72
108 mg/dl /4.06.0 mmol/l).
Antonio Vidal -Puig & Stephen O'rahilly (2001) Nature 413, 125 126.
31
Symptoms of Hypoglycemia
Adrenergic Neuroglycopenic
Shakiness Headache
Irritability Mental illness
Nervousness Inability to
Tachycardia concentrate
Tremor Slurred speech
Hunger Blurred vision
Diaphoresis Confusion
Pallor Irrational behavior
Paresthesias Lethargy
LOC, coma,
34
Interventions
Mild
carbohydrate 10-15 gram
Moderate
20-30 gram of carbs
Glucagon, 1 mg SC or IM
Severe
50% dextrose 25 g IV
Glucagon 1 mg IM or IV
HYPOGLYCEMIA IN DIABETES
CLINICAL RISK FACTORS FOR HYPOGLYCEMIA
IN DIABETES
RR
Tolbutamide 1
Gliclazide 1 - 2(2)
Repaglinide 1-2
Glipizide 2(1)
Glimepiride 3 - 4(3)
Glibenclamide 5(1)
1) Ferner 1988
(2) Teisse, Diab Med,1994
(3) Dills, Horm Metab Res,1996
Hypoglycemic risk