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92 Cards in this Set
- Front
- Back
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What is Diabetes Mellitus?
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A metabolic disorder in which the bodies ability to metabolize simple carbohydrates (glucose) is impaired.
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How is the disease characterized?
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The passage of large quantities of urine containing glucose, significant thirst and deterioration of body function.
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Why does DM occur?
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Either the pancreas does not produce enough insulin or because the cells do not respond to the effects of the insulin that is produced.
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What happens?
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Both cases result in elevated glucose levels in the blood. Glucose builds up in the blood and overflows into the urine and out of the body. Cells can thus starve even though there is plenty of glucose.
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What are the two types of diabetes?
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Type 1 and Type 2
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Who does type 1 diabetes generally strike?
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Children.... It is believed that hereditory and environmental factors may form part of the cause.
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How does type 1 diabetes work?
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Most patients do not produce insulin at all. They require daily injections of synthetic insulin all their lives.
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What is diabetic ketoacidosis?
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Patients with type 1 diabetes required insulin to inhibit production of ketoacids in the body. Failure to take insulin can result in dangerous and occasionally fatal levels of ketoacids in the body.
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How else is type 1 diabetes managed?
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Strict diet control, this can be difficult with young children. Increased activity or alcohol consumption can lead to low blood glucose levels.
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What is type 2 diabetes?
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The most common form of diabetes. In many people the pancreas actually produces enough insulin however the receptor cells have changed in some way and are no longer able to receive the insulin. Others simply do not produce enough insulin.
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What are symptoms of type 2 diabetes?
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Fatigue, nausea, frequent urination, thirst, unexplained weight loss, blurred vision, frequent infections and slow healing of wounds. Being cranky, confused, shaky, unresposiveness and seizure.
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How do the symptoms develop?
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Often gradually and do not become noticeable until middle age. A small percentage of people do not show symptoms at all.
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What is hypoglycemia?
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In the diabetic patient it is often the result of having taken too much insulin or oral medication, too little food, or both.
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What happens to the brain if the blood glucose level drops?
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The brain becomes starved as nerve cells are not able to metabolize fat.
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What symptoms present?
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Trembling, a rapid heart rate, sweating and a feeling of hunger as a result of the action of epinephrine.
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Why epinephrine?
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The disordered function of the hungry brain sets of the alarm reaction (discharge of the sympathetic nervous system).
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What happens if hypoglycemia persists?
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Dysfunction progresses very quickly to permanent brain damage.
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What are additional signs and symptoms are there for hypoglycemia?
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Headache, mental confusion, memory loss, incoordination, slurred speech, irritability, dilated pupils, seizures and coma in severe cases.
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How long before the brain can be damaged?
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The longer the patient remains unconcious the more likely permanent damage. Severe hypoglycemia longer than 30 mins may lead to production of toxic compounds in the brain causing permanent neuronal damage.
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Who else other than diabetics can be prone to episodes of hypoglycemia?
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Alcoholics, ingestion of certain poisons, overdose of drugs (aspirin) certain cancers, liver disease and kidney disease.
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What should you never discount?
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The possibility that hypoglycemia may be present in a comatose patient on the basis that the individual is not known to have diabetes.
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What should you do if you suspect hypoglycemia?
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Treat it imediately! Hypoglycemia is one of the simplest causes of changes in level of awareness to fix.
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Why should you measure the blood glucose if the clinical history suggests stroke?
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Patients with severe hypoglycemia may present with stroke like symptoms. If the comatose patient is older than 55 years or the family gives a history of recent transient ischemic attacks perform a blood glucose test to rule out hypoglycemia.
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How should you treat hypoglycemia?
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If the patient is alert and able to swallow, has an intact gag reflex. Administer glucose by mouth. Use glucose tube, candy bar, non-diet cola drink.
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Who should you not give anything by mouth to?
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A patient whose level of conciousness is depressed.
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Why hold of on use of advanced airways until D50W has been administered?
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If the D50W works the patient will pull out whatever airway when they wake up.
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What is hyperglycemia?
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High blood glucose level, one of the most common presenting features of diabetes mellitus.
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What are early signs and symptoms of hyperglycemia?
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Frequent excessive thirst accompanied by frequent excessive urination.
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Why does hyperglycemia not confirm a diagnosis of diabetes mellitus?
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Hyperglycemia is an independent medical condition with other causes.
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What do the signs of hypoglycemia and hyperglycemia do?
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They tend to overlap, therefore you should check the bgl if any of the symptoms or signs of hypo or hyperglycemia are present.
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When does hyperglycemia occur?
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When the levels of glucose in the blood exceed the normal range.
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What can cause hyperglycemia?
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Excessive food intake, insufficient insulin doses, infection or illness, injury, surgery and emotional stress.
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What is the time of onset?
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Can be rapid (within minutes) or gradual (hours to days) depending on the cause. Excessive food intake may be rapid whereas illness will result in hyperglycemia over the course of several days.
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What does hyperglycemia progress to?
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Diabetic Ketoacidosis (DKA)
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What is diabetic ketoacidosis?
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The body is unable to utilize glucose so turns to other sources principally fat. The metabolism of fat produces acids and ketones as waste products. (The ketones are what give the classic fruity breath of a patient in DKA).
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What results from diabetic ketoacidosis?
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Disturbance of the acid-base balance in the body
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How is glucose extreted from the body?
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Glucose must be excreted in the urine in solution.
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What can happen as a result of this excretion?
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Massive osmotic diuresis due to the high solute concentration of the blood. This along with vomiting can cause dehydration and even shock.
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What if the patient is deeply comatose?
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Patients with DKA are rarely deeply comatose so look for another source for the coma such as head injury, stroke or drug overdose.
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What is polyuria?
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Excessive urine output.
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What is polydipsia?
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Excessive thirst
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What is Polyphagia?
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Excessive eating
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What are the signs and syptoms of DKA?
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Polydipsia, Polyuria, Polyphagia, Nausea and Vomiting, Tachycardia, Deep rapid respirations, warm skin and dry mucous membranes, Fruity odour of ketones on breath, sometimes fever, abdominal pain and hypotension.
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What are kussmaul respirations?
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Deep rapid respirations, the bodies attempt to compensate for metabolic acidosis by blowing off carbon dioxide.
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What are the goals of pre-hospital care of DKA?
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Begin rehydration and to correct the patients electrolyte and acid-base abnormalities.
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How should the airway be supported?
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Follow the procedure for any comatose patient with regards to airway maintenance and oxygen, be alert for vomiting and have suction ready.
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What do elevated T waves mean?
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Changes in serum potassium caused by DKA can lead to marked myocardial instability. If the T waves are peaked the patients potassium level may be dangerously high.
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What is hyperosmolar noketonic coma?
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Known as HONK, also called hyperosmolar hyperglycemic nonketotic coma (HHNC)
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How is HONK or HHNC characterized?
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Characterized by hyperglycemia, hyperosmolarity and an absence of significant ketosis.
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What is do patients present with?
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Severe dehydration and focal or global neurologic deficits, coma is only present in fewer than 10% of cases.
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What patients does HONK / HHNC develop in?
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Develops in patients with diabetes who have some kind of secondary illness that leads to reduced fluid intake. Infection is the most common cause but there are many other conditions that can cause altered mentation or dehydration.
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How does HONK / HHNC work?
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Hyperglycemia and hyperosmolarity lead to osmotic diuresis and osmotic shift of fluid to the intravacular space resulting in severe intracellular dehydration.
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What is the treatement of the HONK / HHNC patient in the pre-hospital setting?
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Follow the pathways for dehydration and altered mental status. Airway management is the top priority. Patient may have extreme fluid deficit of 10l or more.
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What is Adrenal Insufficiency characterized by?
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Decreased function of the adrenal cortex and consequent underproduction of cortisol and aldosterone.
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What is the result of a decrease in the production of cortisol and aldosterone?
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Weakness, dehydration and the bodys inability to maintain blood pressure or to properly respond to stress.
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What does Cortisol do?
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It affects almost every organ and tissue in the body. Its primary role is to with the body's response to stress.
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What else does Cortisol help to do?
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Maintain blood pressure and cardiovascular function; regulates the metabolism of carbohydrates, proteins and fats; affects glucose levels in the blood by balancing the effects of insulin. Functions as an anti inflammatory agent by slowing the inflammatory response.
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What does Aldosterone do?
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Regulates and maintains the Sodium - Potassium balance in the blood.
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How is secretion of this adrenal hormone regulated?
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By the renin-angiotensin system. Also stimulated by increased serum potassium concentrations.
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What does abnormal adrenal cortical function produce?
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Abnormalities in the metabolism of carbohydrates and protein as well as disturbances of salt and water metabolism.
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How is this conditions tolerated?
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Usually very well unless there are coexisting factors such as infection or stress.
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What is primary adrenal insufficiency?
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Also known as Addisons disease. Caused by the atrophy or destruction of both adrenal glands.
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What does this result in?
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Deficiency of all the steroid hormones produced by the adrenal glands.
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What is the mechanism of this disease and how common is it?
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This is a rare disease. Most frequently it is a result of idiopathic atrophy, an autoimmune process in which the immune system creates antibodies attacking the adrenal cortex leading to its gradual destruction.
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At what point does adrenal insufficiency occur?
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When at least 90% of the adrenal cortex has been destroyed.
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What are some other less common causes of of adrenal destruction?
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Tuberculosis, fungal infections, adrenal hemorrhage and cancer of the adrenal glands.
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What happens to the patient with Addison's disease?
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The body fails to to properly regulate the content of sodium, potassium and water in body fluids.
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What happens to these concentrations and to the blood?
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Blood volume and pressure fall as does the concentration of sodium in the blood, blood potassium rises. Blood volume may become so reduced that the circulation can no longer be maintained efficiently.
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What can happen to the smooth muscle tone?
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Can be reduced leading to vasodilatory shock in extreme cases.
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What are the signs of Chronic adrenal insufficiency?
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Unexplained weight loss, fatigue, vomiting, diarrhea, anorexia, salt craving, muscle and joint pain, abdominal pain, postural dizziness and increased pigmentation in the extensor surfaces, palm creases and oral mucosa.
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What is secondary adrenal insufficiency?
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A lack of ACTH secretion from the pituitary gland.
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What does ACTH do?
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It is a pituitary messenger and stimulates the adrenal cortex to produce cortisol.
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What happens if ACTH secretion is insufficient?
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Cortisol production is not stimulated.
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Who else can experience secondary adrenal insufficiency?
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Patients taking corticosteroids who abruptly stop treatment.
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What is an Addisonian Crisis?
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The sudden appearence of signs and symptoms of acute adrenal insufficiency.
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What can cause an Addisonian crisis?
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An acute exacerbation of chronic insufficiency. Brought on by stress, trauma, surgery or severe infection.
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What most commonly causes acute adrenal crisis's?
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Overly rapid reduction of prescribed steroids or abrupt withdrawal.
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What is the primary clinical manifestation of adrenal crisis?
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Shock
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What other symptoms are there?
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Weakness, lethargy, confusion / loss of conciousness, low blood pressure (vascular collapse), elevated temperature, severe pain in lower back, legs or abdomen and severe vomiting and diarrhea that leads to dehydration.
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What can death be caused by?
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Hypotension or cardiac dysrhythmias due to hyperkalemia.
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How is it managed in the prehospital environment?
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Based on the clinical presentation and geared towards maintaining the airway, breathing and circulation until the ER.
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What are the other goals of pre-hospital care?
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Begin rehydration of the patient and correct electrolyte / acid-base abnormalities
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What should you be alert for?
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Vomiting, have suction ready. Check blood glucose levels and administer if patient is hypoglycemic.
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What is Cushings syndrome?
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An excess of cortisol production by the adrenal glands or by excessive use of cortisol or other similar steroid hormones.
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What else can cause cushings syndrome?
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Tumours of the pituitary gland or adrenal cortex can stimulate the production of excess hormone.
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What can this cause?
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Characteristic changes in many body systems. Metabolism of carbs, protein and fat is disturbed such that the blood glucose level rises.
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What happens to protein?
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Protein synthesis is impared so body proteins are broken down leading to a loss of muscle fibre and muscle weakness.
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What happens to bone?
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Bone becomes weaker and more susceptible to fracture.
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What are other common signs and symptoms?
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Weakness and fatigue, depression and mood swings, Increased thirst and urination, high blood glucose level, hypertension
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Where can weight be gained?
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Especially on the abdomen, face, neck and upper back
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What can happen to the skin?
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Thinning with easy bruising and pink or purple stretch marks on abdomen, thighs, breasts and shoulders. Increased acne facial hair growth and scalp hair loss in women
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How is this condition treated in pre-hospital care?
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Obtain a glucose level, monitor the patients blood pressure and treat abnormalities as they present
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