DIABETIC EMERGENCIES
NasruddinKamaruddin
RazziSiti SurayaSarah AliahShuhaidaRohaida
Nurfauzani
DIABETIC KETOACIDOSIS
ROHAIDA CHE MOHD ABDULLAHRAZZI HAJEMI
• Major medical emergency
• Serious cause morbidity
• In type 1 DM
• Usually due to (causes) :– Unknown or newly diagnosed cases of type 1
diabetes– Missed or inadequate doses of insulin, or
spoiled insulin– Intercurrent infection, lose their appetite, stop
or drstically reduced their dose of insulin– Stress, with increasing insulin resistance and
requirement eg: infection, trauma, surgery, myocardial infarction, and stroke.
LACK OF INSULIN1. DECREASED CATABOLISM (glucose)
Hyperglycemia - fatigue
Glycosuria – vulvitis
Osmotic diuresis – polyuria, polidipsia
Salt n water depletion – tachycardia, - hypotension
- dehydration
• Dehydration with decreased perfusion to the tissues leads to lactic acidosis, which contributes to more profound acidosis.
2. INCREASED ANABOLISM
Gluconeogenesis - wastingGlycogenolysis
Lipolysis - loss of weight
Hyperketonemia
Acidosis – hyperventilationPeripheral vasodilation –
hypotension, hypothermia
Diabetic Ketoacidosis
3. INCREASED SECRETION
GlucagonCostisol
CathecolamineGrowth hormone
ANTAGONIZED INSULIN
DEATH !!!
Clinical feature
• As above…• Vomiting• Blurred vision• Abdominal pain (children)• Confusion, drowsiness• Cold peripheries /peripheral cyanosis• Ketone breath (smell of acetone) • Coma (uncommon)
METABOLIC ACIDOSIS
pH - <7.3 / 7.25 () (N – 7.35-7.45)
HCO3 - ?
pH = log 6.1 + [HCO3-]
0.03pCO2
HCO3 - ()
WHY develop hyperventilation?
• The combination of ketoacid formation and dehydration results in metabolic acidosis, and, for compensatory alkalosis,
• rapid deep breathing (Kussmaul respirations) may be manifested at advanced stages
• Kussmaul breathing – to wash out the CO2. thus – patient develop hyperventilation
• The resulting metabolic acidosis – forces the hydrogen ions into cells, displacing potassium ions (whish may lost in urine or through vomiting)
•
H + H + K+
K+ H + H +
K+ H +
K+ H + K+
H + K+
K+
K+
Diagnostic Criteria
• Random Blood Sugar > 11.1 mmol/L
• Ketonemia > 90mg/dL , ketonuria >5000mg/24hr
• Aterial blood gases, pH<7.3/7.25
• HCO3 <15 mmol/L
INVESTIGATION
• Random blood glucose
• Arterial Blood Gases
• Full blood count
• Renal profile
• CXR
• ECG
• Urine FEME
COMPLICATION
• Cerebral Edema (hyponatremia)
• Aspiration pneumonia (coma)
• Hypokalemia
• Hypomagnesaemia
• Hypophosphatemia
• Thromboembolism
REFERENCES
• Oxford Handbook Clinical Medicine
• Davidson’s principle and practice of medicine
• Lippincott’s biochemistry
THANK YOU