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Hyperglycemic Crises

Hyperglycemic Crises and Treatment in DM Patients

What are the two common forms of hyperglycemic crises? - DKA: more common in type I - Hyperglycemia hyper-osmolar state: more common in type II
What are the common causes of DKA in type I DM patients? - insulin NON-compliance - Sub-threapeutic insulin dosing - diseases/ conditions induced: stressor ( infection, MI, trauma) and initial ppt of type I DM -
What is the MOA of DKA why ketones presents? - no insulin --> no uptake of glucose by muscle cells - muscle cells uses TG and AA as sources of energy - the breakdown of TG and AA --> produces fatty acid - Glucagon converts the Fatty Acid --> ketones
What are the lab values used to diagnosis/ recognize pt with DKA? - BG>250mg/dL - ketone production ( urine/serum) + fruity breath - AnionGap : metabolic acidosis: pH<7.35 and gap >12
what is the recommended treatment of DKA in DM pt? 1- fluid: NS until BG reaches 250 --> switch to D5W1/2NS 2- short acting regular insulin bolus: 0.15 units/kg 3- short regular insulin infusion: 0.1 unit/kg/hr 4- prevent insulin induced HYPOkalemi --> monitor K ( 4-5mEq/L) 5- If pH<7-> bicarbs
What are the common causes of HHS in type II DM patients? - severe stress
Dose pt who ppt with HHS test positive for ketone? - NO b/c pt has enough insulin to suppress ketogenesis
What makes the BG level in HHS much more higher than DKA? HHS BG> 600 vs. DAK BG> 250 - acidosis is NOT presented ( pH>7.3)
what are the lab values used to diagnosis/ recognize pt with HHS? 1- BG>600 ( hyperglycemia) 2- high osmolality > 320 mOsm/L ( hyperosmolar) 3- extrem dehydration 4- altered mental status 5- pH> 7.3 with bicarbs >15
what is BG and ph difference between DKA and HHS? - BG> 600 HHS vs. BG> 250 DKA - pH> 7.3 HHS vs. pH< 7.3 DKA - no ketones HHS vs. ketones production DKA - acidosis is not presented HHS vs acidosis is presented DKA
Created by: Smoham38



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