Recommended
More Related Content
What's hot
What's hot (20)
Similar to Manage Hyperglycemic Emergencies Like DKA and HHS
Similar to Manage Hyperglycemic Emergencies Like DKA and HHS (20)
More from SourabHiremath
Recently uploaded
Recently uploaded (20)
Manage Hyperglycemic Emergencies Like DKA and HHS
- 1. HYPERGLYCEMIC EMERGENCIES DR SOURAB HIREMATH MD INTERNAL MEDICINE Emergency Medicine Sugars are High They reach the sky Breath smells of grapes I m under the drapes My breathing is fast I hop I will last Insulin and saline They are the life line
- 2. PRE TEST • DKA and HHS both have same level of elevated glucose levels in body • DKA patients have Cheyne stokes type of breathing • Among ketones most important to cause major symptoms is acetoacetate
- 3. • Treating hyperglycaemia by insulin is more important than correction of hydration by fluids • No need for potassium replacement in DKA on insulin infusion if K+ levels are within normal limit • Rapid reduction of sugars of atleast 150 mg /dl per hour should be done
- 4. STORY OF MAHESH AND SURESH Case of Mahesh Case of Suresh 18 year old boy complains of severe abdominal pain vomiting , loose stools and fever since 3 days Associated with weight loss of around 10 kg in five months h/o polyuria , polydipsia present Past : nothing significant Family : no h/o DM , HTN Personal : Nothing contributory 54 year old male brought to casualty with h/o LOC since 1 hour with 1 episode of GTCS . No fever , vomiting. Past : K/C/O of diabetes since 10 years stopped drugs since 1 month Family : H/o DM in sibling Personal : Nothing significant
- 5. O/E of mahesh O/e of Suresh DROWSY PR : 110/ min BP : 80/ 60 mm of Hg RR : 28 / min Spo2 : 96 % on room air Severely dehydrated Drowsy PR : 120/min Bp : 100/60 mm of Hg RR : 24/min Spo2 : 94 % on room air Severely dehydrated
- 7. O/E OF SURESH • Drowsy • Dehydrated • No ketotic odour • No focal neurological deficits • Other systemic examination is normal
- 8. Mahesh Suresh GRBS : 480 mg/dl RBS : 450 mg/dl Sr HCO3 : 12 meq/dl GRBS : High RBS : 980mg/dl Sr HCO3 : 24 meq/dl
- 9. DIAGNOSIS • Case 1 : DIABETIC KETO ACIDOSIS • Case 2 : Hyperosmolar Hyperglycemic state
- 10. DEFINITION • DKA : State of absolute or relative insulin deficiency characterised By Diabetes : >300mg/dl Ketosis : positive ketones in serum and urine Acidosis : ph <7.30 / HCO <15 meq/L • HHS : High plasma osmolality Sugars usually > 1000 mg /dl
- 12. PATHOPHYSIOLOGY
- 13. CLINICAL FEATURES • Symptoms Classical hyperglycemic symptoms : 3 Ps Gastrointestinal Symptoms : Nausea , vomiting , diarrhea , abdominal pain CNS : Altered sensorium Convulsions Intercurrent infection : fever , dysuria , cough Rapid weight loss
- 14. EXAMINATION • Signs of dehydration • Odour of breath • Signs of acidosis • Signs of intercurrent illness
- 15. DIAGNOSTIC TESTS • CBC • Renal function tests • Arterial blood gas analysis • Osmolarity : 2*Na + glucose /18 + BUN /2.8
- 16. URINE
- 17. GLUCOSE
- 18. OTHER TESTS • Sodium : hyponatremia : 100 mg dl : 1.6 meq/L • Potassium • Phosphorus • ECG • Chest xray
- 20. MANAGEMENT Correction of dehydration Correction of Hyperglycaemia Electrolytes Treatment of precipitating factors DKA/HHS
- 22. FLUID WHEN SUGARS < 200 ????????????????? NS/RL is replaced By 5% Dextrose
- 24. TYPE OF INSULIN USED Use only short acting insulin
- 25. DOSE 0.1 Units /Kg body weight /hour Intravenous Infusion
- 26. OPTIMAL DECLINE OF SUGAR 50-75 mg / dl per hour Avoid rapid reduction
- 28. OTHERS • Bicarbonate correction • Phosphate replacement
- 29. TREATMENT OF INFECTION •Appropriate empirical antibiotics
- 30. COMPLICATIONS • Cerebral edema • Hypokalemia • CVT • MI • Hypoglycemia • Acute pulmonary edema
- 31. THANK YOU