diabetes in acute care
Terms
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- The diagnosis of DKA reflects the patient has
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Ketosis: Acetone positive >1:2
Acidosis: PH<7.35 HCO3 < 18
Hyperglycemic - Precipitating factors of DKA
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Inadequate insulin
Infection
Infarction
Inebriation
Injury
Initial diagnosis
Iatorgenic (thiazides, steroids, Sympathomimetics) - Clinical features of DKA
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Nausea, vomiting, abd pain, polyuria, thirst, sob, altered mental status
dehydration, tachypnea, hypotension, abd tenderness - Laboratory findings of DKA
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Glucose >250
acidosis ph <7.3 HCO3 <18
Ketosis acetone >1:2
Potassium elevated at DX
BUN cr elevated
Na reduced (1.6 meq for every 100 mg elevation in glucose.) - Complications of DKA
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cerebral edema
hyperchloremic metabolic acidosis
non cardiogenic pulmonary edema
hypokalemia
hypoglycemia - Adverse effects of Bicarbonate in the treatment of DKA
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Delayed resolution of ketosis
Cerebral edema
hypokalemia -
HHNK
Hyperosmolar hyperglycemic syndrome elements -
insulin deficiency
renal impairment
cognitive impairment - Clinical findings in HHNK
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Fever,
dehydration
hypotension
tachycardia
hyperventilation
tremors
fasciculations
mental status change
seizure - Lab findings in HHNK
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Glucose >600
Serum acetone normal seldom exceeding 1:2
Osmolality > 350 mOsm/kg
Bicarb >15
ph >7.25
Na 100 -180
K+ 2.2 - 7.8 - Treatment for HHNK
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Fluid replacement 6-8 l over 24 hours
K+ replacement if voiding
Insulin after fluids and electrolyte replacement
dose 1-5 u/h maintain BG 250 first 24 hours - Complications of HHNK
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Hypotension
Cerebral edema
thrombosis - maximum iv insulin dose rate
- 20 U/hr
- what is the 1500 rule
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formula to determine the pts sensitivity factor
ie: 1500/X = sensitivity factor
X = number of units pt receives as daily dose.