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Diabetic Emergancy


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Diabetic Emergancy

  1. 1. 21/05/10 MOH الوكالة المساعدة للطب الوقائي الادارة العامة للأمراض غير المعدية برنامج مكافحة الداء السكري
  2. 2. <ul><li>Diabetic Emergencies </li></ul>
  3. 3. Diabetic Emergencies <ul><li>A diabetic emergency occurs when there is a severe imbalance between the amount of insulin and sugar in the body. </li></ul>
  4. 4. Two conditions may result in a diabetic emergency: <ul><li>Not enough insulin, causing a high level of sugar or hyperglycemia. This could lead to diabetic coma. This may be caused by: </li></ul><ul><li>a) not taking enough insulin </li></ul><ul><li>b) eating too much food </li></ul><ul><li>c) doing less exercise than usual </li></ul><ul><li>Too much insulin, causing a low level of sugar or hypoglycemia. This may lead to insulin shock. This may be caused by: </li></ul><ul><li>a) taking too much insulin </li></ul><ul><li>b) not eating enough food or vomiting </li></ul><ul><li>c) doing more exercise than usual </li></ul>
  5. 5. How to recognize a diabetic emergency <ul><li>A conscious casualty with diabetes might be able to tell you what is wrong. However, keep in mind that the person may be confused. </li></ul><ul><li>An unconscious casualty may be wearing a medical alert bracelet or necklace that will tell you that he/she has diabetes. </li></ul><ul><li>If the casualty cannot tell you what he/she needs, look for the following signs & symptoms: </li></ul>
  6. 6. unsteady walk nausea headache trembling hunger Other signs and symptoms gradual onset of unconsciousness faintness to unconsciousness developing quickly LOC like musty apple or nail polish odourless Breath odour flushed, dry and warm pale and sweating Skin deep and sighing shallow Breathing weak and rapid strong and rapid Pulse Diabetic Coma (needs insulin) Insulin Shock (needs sugar)
  7. 7. First Aid for a diabetic emergency <ul><li>The first aid for insulin shock and diabetic coma is the same: </li></ul><ul><li>Begin scene survey </li></ul><ul><li>If the casualty is unresponsive, get medical help immediately. </li></ul><ul><li>Do a primary survey and give first aid for life-threatening conditions. </li></ul><ul><li>Place the unconscious person into the recovery position and monitor the ABC’s until medical help can take over (Airway- to ensure a clear airway, Breathing- to ensure effective breathing, Circulation- to ensure effective circulation) </li></ul><ul><li>Look for a medical alert device that will give you more information about the casualty’s condition. </li></ul><ul><li>If the casualty is conscious and knows what is wrong: </li></ul><ul><li>Assist him/her to take what is needed – sugar or her prescribed medication </li></ul><ul><li>If the casualty is confused about what is required: </li></ul><ul><li>Give him/her something to eat or drink and get medical help. </li></ul>
  8. 8. Hyperosmolar Hyperglycemic State <ul><li>Hyperosmolar hyperglycemic state (HHS) is one of two serious metabolic derangements that occurs in patients with diabetes mellitus and can be a life-threatening emergency. The condition is characterized by hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis. It less common than the other acute complication of diabetes,  diabetic ketoacidosis (DKA), and usually presents in older patients with  type 2 diabetes mellitus . HHS carries a higher mortality rate than DKA, estimated at approximately 15%.  </li></ul>
  9. 9. The diagnostic features of HHS may include the following: <ul><li>Plasma glucose level of 600 mg/dL or greater </li></ul><ul><li>Effective serum osmolality of 320 mOsm/kg or greater </li></ul><ul><li>Profound dehydration (8-12 L) with elevated serum urea nitrogen (BUN)-to-creatinine ratio </li></ul><ul><li>Small ketonuria and absent-to-low ketonemia </li></ul><ul><li>Bicarbonate concentration greater than 15 mEq/L </li></ul><ul><li>Some alteration in consciousness </li></ul>
  10. 10. Pathophysiology <ul><li>Hyperosmolar hyperglycemic state (HHS) most commonly occurs in patients with type 2 diabetes mellitus who have some concomitant illness that leads to a reduced fluid intake. </li></ul><ul><li>Infection is the most common cause, but many other conditions can cause altered mentation, dehydration, or both. Frequently, the concomitant illness is not identifiable. </li></ul><ul><li>In patients with a preexisting lack of or resistance to insulin, a physiologic stress such as an acute illness can cause further net reduction in circulating insulin.  </li></ul><ul><li>The basic underlying mechanism of HHS is a reduction in the effective circulating insulin with a concomitant elevation of counter-regulatory hormones.  </li></ul><ul><li>Decreased renal clearance and decreased peripheral utilization of glucose lead to hyperglycemia.  </li></ul><ul><li>Hyperglycemia and hyperosmolarity result in an osmotic diuresis and an osmotic shift of fluid to the intravascular space, resulting in further intracellular dehydration.  </li></ul><ul><li>This diuresis also leads to loss of electrolytes, such as sodium and potassium . </li></ul>
  11. 11. Clinical <ul><li>Most patients with hyperosmolar hyperglycemic state (HHS) have a known history of diabetes, which is usually type 2. </li></ul><ul><li>In 30-40% of cases, HHS is the initial presentation of a patient’s diabetes. </li></ul><ul><li>HHS usually develops over a course of days to weeks unlike DKA. </li></ul><ul><li>Often, a preceding illness results in several days of increasing dehydration. </li></ul><ul><li>Adequate oral hydration may be impaired by concurrent acute illness (eg, vomiting) or chronic comorbidity (eg, dementia, immobility). </li></ul><ul><li>Patients may complain of polydipsia, polyuria, weight loss, weakness. Patients do not typically report abdominal pain, which is often seen in DKA. </li></ul>
  12. 12. <ul><li>A wide variety of focal and global neurologic changes may be present, including the following: </li></ul><ul><li>Drowsiness and lethargy </li></ul><ul><li>Delirium </li></ul><ul><li>Coma </li></ul><ul><li>Focal or generalized seizures </li></ul><ul><li>Visual changes or disturbances </li></ul><ul><li>Hemiparesis </li></ul><ul><li>Sensory deficits </li></ul>
  13. 16. 21/05/10 Riyadh PHC / HPTD