30 Questions
Which of the following is a main clinical feature of Diabetic Ketoacidosis (DKA)?
Hyperglycemia
What is the main cause of DKA?
Absence or inadequate amount of insulin
What is the process that leads to dehydration and marked electrolyte loss in DKA?
Osmotic diuresis
What effect does insulin deficiency have on fat breakdown?
Increases fat breakdown
What is the primary consequence of increased gluconeogenesis in DKA?
Hyperglycemia
What are ketone bodies produced from?
Lipolysis
What is the effect of ketone bodies accumulation in the circulation due to lack of insulin?
Metabolic acidosis
What is the estimated maximum water loss in severe DKA over a 24-hour period?
6.5 L
What is a characteristic feature of osmotic diuresis in DKA?
Polyuria
What is the impact of insulin deficiency on glucose metabolism in cells?
Reduces glucose uptake by cells
What is the main reason that patients with HHS do not have the ketosis-related gastrointestinal symptoms?
Their insulin level is high enough to prevent fat breakdown
What is the primary approach to the treatment of HHS?
Fluid replacement, correction of electrolyte imbalances, and insulin administration
Why is close monitoring of volume and electrolyte status important in the treatment of HHS?
To prevent fluid overload, heart failure, and cardiac arrhythmias
When is potassium added to IV fluids in the treatment of HHS?
When urinary output is adequate
Why is insulin usually given at a continuous low rate in the treatment of HHS?
To prevent fat breakdown
What is the range of blood glucose level at which replacement IV fluids with dextrose are given in the treatment of HHS?
Between 250 to 300 mg/dL
How long may it take for neurologic symptoms to clear in the treatment of HHS?
3 to 5 days
After recovery from HHS, how can many patients control their diabetes?
With MNT alone or with MNT and oral antidiabetic medications
What is important in prevention of recurrence of HHS?
Frequent self-blood glucose monitoring (SBGM)
What role does insulin play in the treatment of HHS compared to DKA?
Insulin plays a less important role in the treatment of HHS
Which of the following can lead to insulin resistance in diabetic ketoacidosis (DKA)?
Increased production of 'stress' hormones during illness
How is Hyperglycemic Hyperosmolar Syndrome (HHS) distinguished from DKA?
Absence of ketosis and acidosis
What is a key factor contributing to Hyperglycemic Hyperosmolar Syndrome (HHS) in older adults?
An acute illness or infection
What are the clinical manifestations of Diabetic Ketoacidosis (DKA)?
Polyuria, polydipsia, fatigue
How does insulin deficiency contribute to Diabetic Ketoacidosis (DKA)?
Results from insufficient dosage or patient errors
What is the main effect of insulin deficiency in Hyperglycemic Hyperosmolar Syndrome (HHS)?
Osmotic diuresis resulting in water and electrolyte losses
How can prevention of DKA related to illness be managed?
Not eliminating insulin doses when experiencing nausea and vomiting
What is the underlying cause that should be assessed after the acute phase of DKA?
Psychological reasons for missing insulin doses
What is the result of persistent hyperglycemia in Hyperglycemic Hyperosmolar Syndrome (HHS)?
Osmotic diuresis leading to hypernatremia and increased osmolarity
What is the metabolic disorder most often associated with Hyperglycemic Hyperosmolar Syndrome (HHS)?
Type 2 diabetes
Study Notes
Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS) Overview
- DKA can be caused by missed insulin doses, illness, or undiagnosed diabetes, and insulin deficiency can result from insufficient dosage or patient errors.
- Illness and infections can lead to insulin resistance, causing an increase in "stress" hormones that promote glucose production and interfere with insulin's effects.
- Prevention of DKA related to illness involves "sick day rules" for managing diabetes, including not eliminating insulin doses when experiencing nausea and vomiting and regularly monitoring blood glucose and urine ketones.
- After the acute phase of DKA, underlying causes, including psychological reasons for missing insulin doses, should be assessed, and patients may be referred for evaluation and counseling.
- Clinical manifestations of DKA include polyuria, polydipsia, fatigue, blurred vision, weakness, headache, orthostatic hypotension, hyperventilation, acetone breath, and varying mental status.
- HHS is a metabolic disorder most often associated with type 2 diabetes, resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin, leading to hyperosmolality and hyperglycemia with minimal or absent ketosis.
- The lack of effective insulin in HHS causes osmotic diuresis, resulting in losses of water and electrolytes, and persistent hyperglycemia causes osmotic diuresis, leading to hypernatremia and increased osmolarity.
- HHS often occurs in older adults with no known history of diabetes or type 2 diabetes, traced to an infection or precipitating event such as an acute illness or medication exacerbating hyperglycemia.
- HHS is distinguished from DKA by the absence of ketosis and acidosis, partly due to differences in insulin levels, as no insulin is present in DKA, promoting breakdown of stored glucose, protein, and fat, leading to ketone body production and ketoacidosis.
Test your knowledge about Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS) with this informative quiz. Explore the causes, clinical manifestations, prevention, and management of these serious complications of diabetes.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
