Term
| What are the two types of hyperglycemic crisis? |
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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 |
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Term
| What are the 3 components of DKA? |
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Definition
Hyperglycemia
Acidosis
Ketosis |
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Term
| What are the 3 components of HHS? |
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Definition
Hyperglycemia
Hyperosmolality
Dehydration - can lead to renal failure |
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Term
| What is the most common precipitating factor to HHS and DKA? |
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Definition
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Term
| What places type 1 diabetics at higher risk for DKA? |
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Definition
Young patients have different comorbidities, such as eating disorders
Fear of weight gain and hypoglycemia. Rebellion and stress |
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Term
| How quickly do DKA and HHS develop? |
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Definition
DKA - rapidly, in less than 24 hours
HHS - takes several days to weeks |
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Term
| What are S/S of DKA and HHS? |
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Definition
Polyuria/Polydipsia - hyperglycemia
Weight loss
Vomiting
Dehydration
Weakness
Mental status change - especially HHS |
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Term
| What are the differences in laboratory findings between HHS and DKA? |
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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 |
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Term
| How is anion gap measured? |
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Definition
| AG = Na - (Cl + Bicarb). Normal = 10. |
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Term
| What does acidosis and insulin deficiency do to K+? |
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Definition
Causes potassium to shift OUT of the cells - Hyperkalemia
As this is corrected, shifts back in - can cause an arrhythmia. |
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Term
| What are goals of treatment for HHS and DKA when using IV fluids? |
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Definition
- Expansion if intravascular, interstital, and intracellular volume
- Restoration of renal perfusion |
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Term
| What are the goals for DKA and HHS when using insulin? |
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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 |
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Term
| What else can be given to DKA patients? |
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Definition
| Bicarbonate to correct severe acidosis |
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Term
| When are DKA and HHS considered resolved? |
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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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