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Hyperglycemic crisis
Lecture 11
14
Pharmacology
Professional
09/29/2012

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Term
What are the two types of hyperglycemic crisis?
Definition
- Diabetic Ketoacidosis (DKA) - usually in Type 1 patients (absolute deficiency) but can be in 2. Patients can DIE
- Hyperglycemic hyperglycemic state (HHS) - in type 2 patients (relative deficiency). Don't usually die, but more severe hyperglycemia/dehydration
Term
What are the 3 components of DKA?
Definition
Hyperglycemia
Acidosis
Ketosis
Term
What are the 3 components of HHS?
Definition
Hyperglycemia
Hyperosmolality
Dehydration - can lead to renal failure
Term
What is the most common precipitating factor to HHS and DKA?
Definition
Infection
Term
What places type 1 diabetics at higher risk for DKA?
Definition
Young patients have different comorbidities, such as eating disorders
Fear of weight gain and hypoglycemia. Rebellion and stress
Term
How quickly do DKA and HHS develop?
Definition
DKA - rapidly, in less than 24 hours
HHS - takes several days to weeks
Term
What are S/S of DKA and HHS?
Definition
Polyuria/Polydipsia - hyperglycemia
Weight loss
Vomiting
Dehydration
Weakness
Mental status change - especially HHS
Term
What are the differences in laboratory findings between HHS and DKA?
Definition
HHS normally has more significant lab values, such as a BG > 600. Also will not be acidotic.
DKA will have a low bicarb, a possible anion gap. Ketone strips can underestimate acidosis. Directly measure beta-hydroxybutyric acid
Term
How is anion gap measured?
Definition
AG = Na - (Cl + Bicarb). Normal = 10.
Term
What does acidosis and insulin deficiency do to K+?
Definition
Causes potassium to shift OUT of the cells - Hyperkalemia
As this is corrected, shifts back in - can cause an arrhythmia.
Term
What are goals of treatment for HHS and DKA when using IV fluids?
Definition
- Expansion if intravascular, interstital, and intracellular volume
- Restoration of renal perfusion
Term
What are the goals for DKA and HHS when using insulin?
Definition
- SHUT OFF lipolysis
- Decrease BG to 150-200 in DKA, 200-300 in HHS. 50-75 mg/dL drop/hour
- Hold insulin if K < 3.3 and give K+ supplements
Term
What else can be given to DKA patients?
Definition
Bicarbonate to correct severe acidosis
Term
When are DKA and HHS considered resolved?
Definition
- DKA - BG < 200 AND 2 of the following: HCO3 > 15, pH > 7.3, AG < 12
- HHS - normal osmolality and mental status.
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