Contains current information on the management of diabetic emergencies.

1. Diabetic Emergencies
PRESENTED BY
DR MBOMA CEPHAS

7. CLINICAL FEATURES OF DM
•POLYURIA
•POLYDYPSIAPOLYDYPSIA
•POLYPHAGIA
•WT LOSS

8. Diabetic Emergencies
• Diabetic ketoacidosis(DKA)
• Hyperosmolar non-ketotic state(HONK) or
hyperosmolar hyperglycemic state(HHS)
• Hypoglycemia

12. Management

13. Unconscious

19. Pathophysiology

20. Pathophysiology Cont’d

21. Pathophysiology Cont’d

40. Management of HHS
Investigations
• Blood glucose
• Arterial blood gases and pH
• U+Es• U+Es
• Plasma osmolarity: (mmol/L)= 2[Na+K] +[urea]+ [glucose]
• CRP, CK, troponin T
• ECG and CXR
• FBC,Blood & urine cultures/swabs

42. Fluid replacement
• 0.9% N/S or 5% D/S infusion is given
intravenously.
• To correct the dehydration is likely to be in the• To correct the dehydration is likely to be in the
range of 4-9L
• 10% Dextrose should be given when the blood
glucose concentration falls to < 15mmol/L.

43. Insulin
• Dilute 50 units of human Actrapid insulin to
50mL with 0.9%N/S and infuse IV via a syringe
pump.
• Commence at a rate of 3 units per hour.
• Aim for a 2-4mmol/L decrease in glucose per
hour.

44. Potassium(k+)
• k+ replacement is required, but should be
started only when;
renal function is satisfactory or
the plasma potassium concentration is low.the plasma potassium concentration is low.
Potassium requirements are much less than in
DKA

45. Further management
• Give subcutaneous dalteparin (if no contra-
indications):
 5000 units OD if patient > 40 years
 2500units OD if patient < 40 years
• Establish the cause of HONK and treat where
appropriate.
• Once stabilised, the patient can continue with
previous oral hypoglycaemic or insulin therapy.