Complications Of Dm 1 And 2: Dka Vs Hhnk

Front 1

Diabetic Ketoacidosis (DKA)

Back 1

1. state of intracellular dehydration as a result of elevated blood glucose levels
2. often, an acute complication of DM 1
May be presenting sign of DM

Front 2

Diabetic Ketoacidosis (DKA)
Signs and Symptoms

Back 2

1. polyuria, including nocturia
2. polydipsia
3. weakness/fatigue, N and V
4. Kussmaul's breathing (trying to blow off co2)
5. altered LOC
6. fruity breath
7. hypotension and tachycardia
8. poor skin turgor

Front 3

Diabetic Ketoacidosis (DKA)
Laboratory/Diagnostics

Back 3

1. hyperglycemia (serum glucose >250 mg/dL and frequently >300
2. Ketonemia and/or ketonuria
3. marked glycosuria
4. Acidosis (pH<7.30): Metabolic
5. Elevated hct, BUN/Cr
6. Hyperkaleia
7. hyperosmolality: mosm/L=
a. 2(Na(mEq/L +K (mEq/L) + Glucose/18)

Front 4

Diabetic Ketoacidosis (DKA)
Management

Back 4

1. protect airway; administer 02
2. refer for: fluid resuscitation: isotonic fluids (NS), then 1/2 NS, followed by D51/2NS
b. u/kg regular insulin IV bolus followed by 0.1 u/kg/hr
c. supportive care

Front 5

Hyperosmolar Hyperglycemic Non-Ketosis (HHNK) DM2

Back 5

1. state of greatly elevated serum glucose, hyperosmolality and severe dehydration, without ketone production
2. usually occurs as a complication of DM 2
3. pt cannot produce enough insulin to prevent severe hyperglycemia, osmotic diuresis and extracellular fluid depletion
4. mortality rates 30-50%

Front 6

Hyperosmolar Hyperglycemic Non-Ketosis (HHNK) DM2

Signs and Symptoms

Back 6

1. polyuria
2. weakness
3. altered LOC
4. hypotension
5. tachycardia
6. poor skin turgor
7. other signs of dehydration

Look into "shock"

Front 7

Hyperosmolar Hyperglycemic Non-Ketosis (HHNK) DM2
Laboratory/Diagnostics

Back 7

1. greatly elevated serum glucose (>600 mg.dL; commonly >1000 mg/dL
2. Hyperosmolality (>310 mOsm/L)
3. elevated BUN/Cr
4. elevated HGb A1c
5. relatively normal pH
6 Normal anion gap

Front 8

Hyperosmolar Hyperglycemic Non-Ketosis (HHNK) DM2
Management

Back 8

1. protect airway, administer 02
2. refer for:
a. NS IV massive fluid replacement (overall deficit may be 6-10 litersl, then 1/2 NS, followed by D51/2NS
b. 15 U regular insulin IV, followed by 10 to 15 U SQ immediately
c. additional insulin depends on severity of condition and response0may not be necessary
d. supportive care (palliative, heart problems.