Diabetic emergency

1. Diabetic
Emergencies

2. Synopsis:
• Diabetic Ketacidosis(DKA)
• Hypoglycemia
• Hyperosmolar hyperglycemic nonketotic
syndrome(HONK)

3. Diabetic Ketoacidosis
• Diabetic ketoacidosis(DKA) is a medical
emergency principally seen in type 1 diabetes
• It is a serious cause of morbidity in
children - cerebral oedema
adults - hypokalemia,
ARDS
• Occurs because of failure to increase insulin dose
appropriately to compensate the stress response

4. • Hyperketonemia(>3mmol/L) and
ketonuria(>2+)
• Hyperglycemia(>200mg/dl)
• Metabolic acidosis(pH<7.3)
Insufficient Insulin
Proteolysis Lipolysis
Glycogenolysis Gluconeogensis
FFA and glycerol
to liver
Glucose uptake
and utilization
Hyperglycemia Ketogenesis
Metablic acidosis

5. Clinical features:
Symptoms Signs
1. Polyuria, thirst
2. Weight loss
3. Weakness
4. Nausea, vomiting
5. Leg cramps
6. Blurred vision
7. Abdominal pain
1. Dehydration
2. Hypotension
3. Cold extremeties/ peripheral
cyanosis
4. Tachycardia
5. Kussmaul breathing
6. Smell of acetone
7. Hypothermia
8. Confusion, drowsiness,
coma

6. • A 20 year-old male was taken to the
emergency room because of drowsiness, fever,
cough, diffuse abdominal pain, and vomiting.
Fever and cough started 2 days ago and the
patient could not eat or drink water.
On examination he was tachypneic, his
temperature was 39° C (102.2° F), pulse rate 104
beats per minute, respiratory rate 24 breaths
per minute, supine blood pressure 100/70 mm
Hg. He also had dry mucous membranes, poor
skin turgor, and rales in the right lower chest. He
was slightly confused.

7. Investigations
• Venous blood ( glucose, urea and electrolytes,
acid- base status)
• Complete blood count
• Urine analysis for ketones and sugar
• ECG
• Infection screen ( Blood count; Blood/Urine
culture, CXR)

8. Lab Findings
• Hemoglobin 14.3 g/dl
• White blood cell count 15,000/ μ l,
• Glucose 450 mg/dl
• Urea 60 mg/dl , creatinine 1.4 mg/dl
• Na+ 152 mEq/L, K+ - 5.3 mEq/L, PO4 3−2.3
mEq/L (0.74 mmol/L), and Cl− 110 mmol/L.
• Arterial pH was 6.9, PO2 - 95 mmHg, PCO2 -28
mmHg, HCO3−9 mEq/L, and O2 sat- 98%.
• The result of the strip for ketone bodies in
urine was strongly positive.
• Urinalysis showed glucose 800 mg/dl and
specific gravity 1030.

9. Management
• Replacement of fluid losses
• Correction of Hyperglycemia/ Metabolic
acidosis
• Maintaining electrolyte balance
• Detection and Treatment of Precipitating
causes