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    DKA/HHS

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    Caroline Ratu
    The document discusses diabetes mellitus, a metabolic disorder characterized by chronic hyperglycemia caused by defects in insulin secretion or action. It outlines the typical symptoms, types of diabetes, acute complications like diabetic ketoacidosis and hyperglycemic hyperosmolar state, and their treatment which involves hydration, insulin therapy, and correcting electrolyte and pH imbalances.

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    DKA/HHS

    Uploaded by

    Caroline Ratu
    20 views3 pages
    The document discusses diabetes mellitus, a metabolic disorder characterized by chronic hyperglycemia caused by defects in insulin secretion or action. It outlines the typical symptoms, types of diabetes, acute complications like diabetic ketoacidosis and hyperglycemic hyperosmolar state, and their treatment which involves hydration, insulin therapy, and correcting electrolyte and pH imbalances.

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    The document discusses diabetes mellitus, a metabolic disorder characterized by chronic hyperglycemia caused by defects in insulin secretion or action. It outlines the typical symptoms, types of diabetes, acute complications like diabetic ketoacidosis and hyperglycemic hyperosmolar state, and their treatment which involves hydration, insulin therapy, and correcting electrolyte and pH imbalances.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    20 views3 pages

    DKA/HHS

    Uploaded by

    Caroline Ratu
    The document discusses diabetes mellitus, a metabolic disorder characterized by chronic hyperglycemia caused by defects in insulin secretion or action. It outlines the typical symptoms, types of diabetes, acute complications like diabetic ketoacidosis and hyperglycemic hyperosmolar state, and their treatment which involves hydration, insulin therapy, and correcting electrolyte and pH imbalances.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    You are on page 1of 3

    DIABETES MELLITUS – a metabolic disorder of multiple aetiology, characterized by chronic

    hyperglycemia in which CHO, protein and fat metabolism is disturbed because of the defects in
    insulin secretion, insulin action or both.

    Dx of DIABETES
    Typical Symptoms:
    • Random plasma glucose ≥ 11.1mmol/l
    • 3P’s: polyuria, polydipsia,
    with classical s/s: 3Ps + weight loss
    polyphagia
    Asymptomatic  2 +ve tests on separate
    • Unexplained weight loss
    occasions: Major types of primary DM are:
    • Fasting plasma glucose ≥ 7mmol/l (NB: • Type 1
    • Lethargy
    no food intake for 8hrs) • Type 2
    • Gestational diabetes
    • Pruritis vulvae- itching of
    • 2hr plasma glucose ≥ 11.1mmol/l
    the vulva
    during an oral glucose tolerance (75g
    sugary drink) Acute Complications:
    • DKA • Balanitis- inf. of the glans
    • HHS penis
    • HbA1c ≥ 6.5% (measures blood sugar
    • Hypoglycemia
    for at least 3mo)
    DKA Hyperglycemic
    Hyperosmolar State HHS Dx:
    (HHS) DKA Dx:
    Plasma glucose >13.9mmol/l Plasma glucose > 20mmol/l
    Absolute insulin deficiency Relative insulin deficiency pH> 7.3
    resulting: resulting in: pH <7.3
    HCO3- <15 HCO3- >20
    • Severe hyperglycemia • Profound
    • Ketone acid hyperglycemia Serum + urine ketones (+ve) Serum + urine (-ve)
    production • Hyperosmolality
    • Altered level of
    • Develops over hours to consciousness
    1-2 days • Dehydration NB:
    • No significant ketone
    • s/s: dyspnea, abd.pain, production • Ketones are  beta oxidation of fatty acids
    nausea, vomiting, acetone, acetoacetate and beta oxybutyric acid
    acetone breath, • Develops over days to
    kussmaul’s breathing wks Evaluation:
    • High mortality rate – • Serum glucose
    20%
    • Serum electrolytes (anion gap)
    • Anion Gap: • Plasma Osmolality: • FBC
    Na – (Cl + HCO3) = (Na x 2) + (Glucose/8)
    mmol/kg • Urinalysis and urine ketones by dipstick
    Normal = 8-12mmol/l • Plasma osmolality (Posm)
    Risk of neurologic • serum ketones (if urine ketones is present)
    decompensation once • ABGs
    Posm > 320 mmol/kg • ECG
    Mx: DKA, HHS

    • Fast hydration
    1st L of NS  bolus (30mins)
    2nd L  1st hr
    3rd L  2hr
    4th L  4hrs

    • Insulin infusion – 0.1 units/kg


    Once glucose is 14mmol/l  half Insulin doses then can give Insulin SC bd dosing + add
    dextrose to KCL

    • K+
    Add it in during the 3rd or 4th hr of hydration

    • When blood pH is <7  may infuse Sodium Bicarbonate- over 1hr

    • Tx the underlying cause

    • Monitor UO (IDC), CBG, electrolytes, O2 therapy if required

    • However, for HHS, one is stable  pt can be switched to oral hypoglycemic

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