Acute complications of D.M

1) Hypoglycaemia.

2) D.K.A

3) H.N.C

4) L.A

Cont.

Acute complications of diabetes are medical emergencies.

Both type1 and type2 diabetes can experience life threatening crises.

HYPOGLYCAEMIA

DefinitionLowered blood glucose level

<2.5mg\dlMortality rate 2% to 4%

Risk factors

1)Missed meal . 2)Unexpected exercise.

3)Alcohol . 4)Poorly designed insulin.5)Defective glucose counter regulation.6)Gastro paresis. 7)Addison's disease.8)Mal absorption. 9)Liver failure.

C\P

1)Autonomic activation

2)Neuroglycopenic

Morbidity

CNS…coma brain damage CVA TIACVS…cardiac arrhythmias MIEYE…vitreous hemorrhage worsening

retinopathy

Investigations

RBS…BF…LFT…U\S

Treatment

1)Oral glucose

2)IV dextrose

3)Glucagons

D.K.A

DefinitionAbsolute insulin def, with hyperglycemia

>300mg\dl Lipolysis ..hyperketonaemia and

acidosis

Risk factors

1) New cases

2) Infections

3) Surgery... trauma e.g. MI

4) Interruption of insulin administration

5) Emotional factors and stress

C\P

1) Abdominal pain, nausea and vomiting

2) S\S of dehydration

3) Polyuria

4) Kussmaul respiration

Investigations

1) Urine……glucosuria and ketonuria

2) Blood…...hyperglycaemia>300mg/dl

3) Serum electrolytes(Na, K, Ph,…)

4) AGB and PH

5) Plasma bicarbonate <12mmol/L

Management

Correction of dehydrationCorrection of hyperglycemiaCorrection of electrolytes Treatment of infection

Hyper osmolar Non Ketotic Coma

DefinitionRelative insulin def, +hyperglycemia

>600mg/dl ass. With increase serum osmolarity >310

mosm/LSever dehydration + stupor….coma

Risk factors

1) Age

2) Dehydration

3) Acute illness

4) Cerebrovascular disease

5) Medications…steroids…thiazids

C\P

S\S of sever dehydrationStupor……..Coma

Investigation

1) Measurement of plasma osmolarity

2[Na] +2[k] + [glucose] + [urea]

N… (280 to 300)

2) RBS

3) Urine

Treatment

Correct dehydrationCorrect hyperglycemiaCorrect electrolytes

Lactic acidosis

DefinitionLactic acidemia >2mmol/L + acidosis

(PH<7.3) andWithout ketoacidosis maybe low keton

level

Risk factors

1) Sex

2) Age

3) Hypoxia

4) Drugs

5) Acute illness

C\P

• Similar to DKA

Investigations

1) RBS

2) PH AND Bicarbonate levels

3) Lactic acid level

Treatment

DehydrationsElectrolytes balanceCorrection of acidosisCorrection of hyperglycemia