Podcast Beta
Questions and Answers
What is the approximate mortality rate associated with a single episode of DKA?
What is the primary cause of death in patients with DKA?
Which type of diabetes is DKA most commonly associated with?
What is the minimum blood glucose level required for diagnosis of DKA?
Signup and view all the answers
What is the primary difference between DKA and HHS in terms of pathogenesis?
Signup and view all the answers
What is the common finding in patients with HHS?
Signup and view all the answers
What is the estimated fluid loss in a person weighing 100 kg with HHS?
Signup and view all the answers
What is the mortality rate associated with HHS?
Signup and view all the answers
Why do people with HHS not develop significant ketoacidosis?
Signup and view all the answers
What is a common precipitating factor for HHS?
Signup and view all the answers
What is a poor prognostic sign for HHS?
Signup and view all the answers
What is a key goal of managing HHS?
Signup and view all the answers
Why should fluid replacement be less aggressive in HHS?
Signup and view all the answers
What is a concern in older patients with HHS?
Signup and view all the answers
How should the rate of glucose lowering be guided in HHS?
Signup and view all the answers
Why is a slower approach to correction of electrolyte and metabolic abnormalities preferred in HHS?
Signup and view all the answers
Study Notes
Diabetic Ketoacidosis (DKA)
- Acute metabolic complication of diabetes resulting from absolute insulin deficiency, and a medical emergency with important complications
- Mortality rates have fallen in the UK, but a single episode is associated with a 5% risk of death, rising to 25% in recurrent cases
- Most commonly occurs in people with type 1 diabetes, but can also occur in type 2 diabetes, particularly in those with significant β-cell dysfunction
Diagnosis of DKA
- Hyperglycaemia (blood glucose >11.1 mmol/L or 200 mg/dL)
- Hyperketonemia (≥3.0 mmol/L on fingerprick testing) or ketonuria (more than 2+ on urine dipstick testing)
- Metabolic acidosis (venous bicarbonate <15 mmol/L or pH <7.3)
Hyperosmolar Hyperglycemic State (HHS)
- Associated with a higher mortality rate (up to 20%) due to age and frailty of the population
- Pathogenesis is incompletely understood
- Caused by an osmotic diuresis, leading to dehydration and hypernatraemia
- Fluid loss can be substantial (10-22 L in a person weighing 100 kg)
- Reason for lack of significant ketoacidosis is unclear, possibly due to insulin levels sufficient to prevent lipolysis and ketogenesis
Precipitating Factors and Prognosis of HHS
- Common precipitating factors: infection, acute illness, drug therapy, and postoperative hospitalization
- Poor prognostic signs: hypothermia, hypotension, serum osmolality >360 mOsmol/kg, and multiple comorbidities
Management of HHS
- Aims: normalize osmolality and blood glucose, replace fluid and electrolyte losses, and prevent complications
- Slower approach to correction of metabolic abnormalities recommended, avoiding rapid shifts in osmolality
- Co-morbidities must be taken into account, such as cardiac failure and delirium
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge of Diabetic Ketoacidosis, a medical emergency and acute metabolic complication of diabetes, its diagnosis, and risks.
