The document discusses diabetic emergencies such as diabetic ketoacidosis (DKA), hyperosmolar non-ketotic state (HONK), and hypoglycemia. It provides details on the clinical features, pathophysiology, investigations, and management of HONK. Key aspects of management include fluid replacement, insulin therapy to gradually lower blood glucose levels, and potassium replacement if needed. Once stabilized, treatment involves establishing the cause of HONK and continuing previous diabetes medications.

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.