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Diabetic Emergencies | DKA | Hyperglycemia

Diabetic Ketoacidosis – DKA: diabetic person has inadequate insulin circulating to control blood sugar levels. Also there’s excess epinephrine and glucagons present. Blood sugar level rises, fatty tissue breaks down forming ketones and ketoacids >>> changes blood acid/base balance >>>frequent urination >>>dehydration >>>loss of body chemicals (potassium) >>> chain of events leads downhill.

Takes longer/more problems than hypoglycemia. Usually starts with an infection. Too small dose of (or forgot to take) insulin.

Signs and Symptoms:

  • Weakness, nausea, vomiting (of course, more vomiting)
  • Abdominal pain
  • Polyurea, polydipsea
  • Kussmaul respirations
  • Altered LOC
  • Fruity, acetone odor to breath (not always) Normal BP or mile hypotension
  • Rapid, weak pulse

Emergency Care:

  • Control the airway
  • Give High concentration O2 (94% Spo2)
  • Monitor the ECG
  • Start an IV and draw a blood sample.
  • Fluid bolus usually 500-1000mL Normal Saline or Lactated Ringer’s
  • Watch for shock
  • Nothing by mouth, Never give insulin
  • Transport
  • Psychological support

Hyperglycemic Hyperosmolar Non Ketotic Coma (HHNC): Relative insulin deficiency, high levels of glucose in the CSF >>> but no ketones present >>> dehydration of the brain and decreased level of consciousness. Most at risk:

  • People over 60
  • Precipitated by infection, extreme cold or dehydration
  • Gradual deterioration over 4-5 days
  • No Kussmaul breathing, no fruity breath (because no acidosis)

Managing Diabetic Patients: Always ask?

What did you eat today?
Did you take your insulin?
Has the dosage changed?
Are you under any unusual stress?

Physical Assessment: Look for:

Altered Mental Status
Kussmaul respirations
Tachycardia
Hypotension
Skin color, temperature
Hydration status

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