Management of Hyperglycemic Crisis in Patients with Diabetes

Sodium-glucose co-transporter 2 (SGLT2) inhibitors, , should be discontinued why ?

can precipitate DKA

Common causes of DKA include:

infection noncompliance inappropriate adjustment of insulin cessation of insulin new-onset diabetes mellitus myocardial ischemia.

Why should Insulin be delayed if K+ is increased?

insulin will worsen the hypokalemia by driving potassium into the cells, and this could trigger cardiac arrhythmias.

What should be done upon physical examination?

1. Patency of airway 2. Mental status 3. Sources of infection 4. cardiovascular & renal status 5. state of hydration

What is the next step in Tx of DKA and HHS after the infusion of isotonic saline?

Correct K+ Deficit ( if present)

Common Tx of DKA & HHS

Correction of fluid and electrolyte abnormalities Administration of insulin Fluid replacement Potassium replacement

What are the two most serious acute complications of diabetes?

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state ( hyperosmolar)

What drugs can precipitate in the development of DKA and HHS?

Excessive use of diuretics, corticosteroids, alpha and beta adrenergic blockers, sympathomimetic agents.

True/False IV regular insulin and rapid-acting insulin analogs are not equally effective in treating DKA.

False

True/False There is a ton of Ketoacid accumalation in HHS?

False ( show table)

True/False DKA can have symptoms for several days before admission. ( polydipsia, polyuria, weight loss.

False usually seen in HHS

Routine Phosphate replacement is preferred in DKA and HHS ?

False, strongly considered if severe hypophosphatemia occurs (serum phosphate concentration below 1 mg/dL or 0.32 mmol/L), especially if cardiac dysfunction, hemolytic anemia, and/or respiratory depression develop

DKA triad?

Hyperglycemia, ketonemia, and acidemia

What are the most common complications of DKA and HHS?

Hypoglycemia and hypokalemia

What is the first step in the treatment of DKA and HHS?

Infusion of isotonic saline

What type of insulin should be administered to all patients with mod - severe DKA with a serum K+ greater than or equal to 3.3 mEq/L

Low- Dose IV insulin

Early signs of DKA ?

Nausea Vomiting Abdominal pain Hyperventilation

DKA and HHS have similar treatments

True

True/False If the serum potassium is less than 3.3 mEq/L, insulin therapy should be delayed until potassium replacement has begun and the serum potassium concentration has increased.

True

True/ False DKA and HHS differ clinically according to the presence of ketoacidosis and, usually, the degree of hyperglycemia

True ( show comparison chart)

When is dextrose added to the saline solution in DKA?

When serum glucose declines to 200 mg/dL

IV electrolyte and fluid replacement corrects ?

both hypovolemia and hyperosmolality.

What is a major finding in DKA?

metabolic acidosis

The earliest symptoms of marked hyperglycemia are ?

polyuria polydipsia weight loss

What labs should be ordered ?

serum glucose, urinalysis and urine ketones, serum electrolytes, BUN and creatinine, plasma osmolality, mixed venous blood gas, electrocardiogram; add serum ketones if urine ketones present.

Why is it important to administer isotonic saline ?

to expand extracellular volume and stabilize cardiovascular status ( also increases insulin responsiveness) - reducing plasma osmolality