Chapter 19 Endocrine and Hematologic Emergencies Review

A 45-year-old man with type 1 diabetes is found unresponsive. Which of the following questions is MOST important to ask his wife? A. "Did he take his insulin today?" B. "How long has he been a diabetic?" C. "Has he seen his physician recently?" D. "What kind of insulin does he take?"

A Rationale: All of these questions are important to ask the spouse of an unconscious diabetic. However, it is critical to ask if the patient took his insulin. This will help you differentiate hypoglycemic crisis from hyperglycemic crisis. For example, if the patient took his insulin and did not eat, or accidentally took too much insulin, you should suspect hypoglycemic crisis. If the patient did not take his insulin, you should suspect hyperglycemic crisis.

If the cells do not receive glucose, they will begin to metabolize: A. fat. B. acid. C. sugar. D. ketones.

A Rationale: If the body's cells do not receive glucose, they will begin to metabolize the next most readily available substance—fat. Fat metabolism results in the production of ketoacids, which are released into the bloodstream (hence the term "ketoacidosis").

A diabetic patient presents with a blood glucose level of 310 mg/dL and severe dehydration. The patient's dehydration is the result of: A. excretion of glucose and water from the kidneys. B. a deficiency of insulin that causes internal fluid loss. C. an infection that often accompanies hyperglycemia. D. an inability to produce energy because of insulin depletion.

A Rationale: In severe hyperglycemia, the kidneys excrete excess glucose from the body. This process requires a large amount of water to accomplish; therefore, water is excreted with the glucose, resulting in dehydration.

Patients with diabetic ketoacidosis experience polydipsia because: A. they are dehydrated secondary to excessive urination. B. the cells of the body are starved due to a lack of glucose. C. fatty acids are being metabolized at the cellular level. D. hyperglycemia usually causes severe internal water loss.

A Rationale: Severe hyperglycemia—which leads to diabetic ketoacidosis—causes the body to excrete large amounts of glucose and water. As a result, the patient becomes severely dehydrated, which leads to excessive thirst (polydipsia).

A 19-year-old diabetic male was found unresponsive on the couch by his roommate. After confirming that the patient is unresponsive, you should: A. suction his oropharynx. B. manually open his airway. C. administer high-flow oxygen. D. begin assisting his ventilations.

B Rationale: Immediately after determining that a patient is unresponsive, your first action should be to manually open his or her airway (eg, head tilt-chin lift, jaw-thrust). Use suction as needed to clear secretions from the patient's mouth. After manually opening the airway and ensuring it is clear of obstructions, insert a nasal airway adjunct and then assess the patient's breathing.

Which combination of factors would MOST likely cause a hypoglycemic crisis in a diabetic patient? A. Eating a meal and taking insulin B. Skipping a meal and taking insulin C. Eating a meal and not taking insulin D. Skipping a meal and not taking insulin

B Rationale: The combination that would most likely cause a hypoglycemic crisis is skipping a meal and taking insulin. The patient will use up all available glucose in the bloodstream and become hypoglycemic. Left untreated, hypoglycemic crisis may cause permanent brain damage or even death.

Type 1 diabetes is a condition in which: A. too much insulin is produced. B. glucose utilization is impaired. C. too much glucose enters the cell. D. the body does not produce glucose.

B Rationale: Type 1 diabetes is a disease in which the pancreas fails to produce enough insulin (or produces none at all). Insulin is a hormone that promotes the uptake of sugar from the bloodstream and into the cells. Without insulin, glucose utilization is impaired because it cannot enter the cell.

What breathing pattern would you MOST likely encounter in a patient with diabetic ketoacidosis (DKA)? A. Slow and shallow B. Shallow and irregular C. Rapid and deep D. Slow and irregular

C Rationale: Kussmaul respirations—a rapid and deep breathing pattern seen in patients with DKA—indicates that the body is attempting to eliminate ketones via the respiratory system. A fruity or acetone breath odor is usually present in patients with Kussmaul respirations.

In contrast to a hyperglycemic crisis, a hypoglycemic crisis: A. rarely presents with seizures. B. presents over a period of hours to days. C. should not routinely be treated with glucose. D. usually responds immediately after treatment.

D Rationale: Hypoglycemic crisis usually responds immediately following treatment with glucose. Patients with hyperglycemic crisis generally respond to treatment gradually, within 6-12 hours following the appropriate treatment. Seizures can occur with both hyperglycemic crisis and hypoglycemic crisis, but are more common in patients with hypoglycemic crisis.

A woman called EMS because her 12-year-old son, who had been experiencing excessive urination, thirst, and hunger for the past 36 hours, has an altered mental status and is breathing fast. You should be MOST suspicious for: A. low blood sugar. B. hypoglycemia. C. hypoglycemic crisis. D. hyperglycemic crisis.

D Rationale: The child is experiencing a hyperglycemic crisis secondary to severe hyperglycemia. Hyperglycemic crisis is characterized by a slow onset and excessive urination (polyuria), thirst (polydipsia), and hunger (polyphagia). Other signs include rapid, deep breathing with a fruity or acetone breath odor (Kussmaul respirations); a rapid, thready pulse; and an altered mental status.