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Diabetic emergencies

Diabetic emergencies. Dr. Miada Mahmoud Rady. Objectives. 1- Define D.M , its types and lines of treatment. 2- Hypoglycemia and its proper management . 3- Understand approach to patient with DKA and HONK. Diabetes mellitus.

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Diabetic emergencies

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  1. Diabetic emergencies Dr. Miada Mahmoud Rady

  2. Objectives 1- Define D.M , its types and lines of treatment. 2- Hypoglycemia and its proper management . 3- Understand approach to patient with DKA and HONK.

  3. Diabetes mellitus • Metabolic disorder caused impaired body ability to utilize carbohydrate . • Caused by deficiency or inefficiency of insulin. • Insulin is peptide hormone secreted from ß – cells of islet of langerhans of pancreas. • Types : • Type 1 D.M : occurs on children. • Type 2 D.M : occurs in adult . • Gestational D.M : during pregnancy .

  4. Glucose Food of the cell cell Pathophysiology and clinical presentation of D.M Weight loss insulin Hyperglycemia (D.M ) polyphagia tissues nerves kidney eye Increased infection Blurring of vision Tingling , numbness Polyuria polydepsia

  5. Gestational D.M • Glucose intolerance during pregnancy. • Caused by maternal hormones . • Increases risk of type 2 diabetes. • May result in large babies . • Resolves after delivery for most women.

  6. Complication of D.M • Brain : cerebrovascular disease , stroke. • Eye : cataract , blindness. • Cardiovascular : atherosclerosis , ischemic heart disease (IHD) , hypertension (HTN) . • Kidney : renal failure . • Nervous system : peripheral neuropathy.

  7. Diagnosis of D.M NORMAL PREDIABETES DIABETES

  8. Emergencies of D.M • Hypoglycemia • Hyperglycemia • Diabetic ketoacidosis ( DKA ) • Hyperosmolar non-ketotic coma (HONK) • pancreatitis.

  9. HYPOGLYCEMIA • Occurs in : both diabetics and non diabetics . • Causes : • Over dose of oral hypoglycemic or oral diabetics. • Missed meals . • Both. • Diagnosis : blood glucose level : < 45mg /dl or less . • Presenting complaint: Remember SAD FISH

  10. Management • Should be treated rapidly as it may leads to brain damage . • If patient is alert , give oral sugars. • If patient is confused : • Secure an I.V access and give D50 12.5 to25 gm over 3 minutes followed by saline flush . • No I.V access available , give I.M glucagon . • Do not use an advanced airway until you have given the patient D50.

  11. DKA • Causes : neglected and uncontrolled D.M. • Predisposing factors :infection , stress , operations . • More common in type 1 ( ketoliable ) . • Pathophysiology :acids accumulate in blood due to insulin lack.

  12. Clinical presentation : • symptoms : • Polysymptoms of uncontrolled D.M • Abdominal pain , Nausea , Vomiting and Diarrhea . • Patient with DKA are rarely comatosed. DKA may present with acute abdomen

  13. Signs : • Acetone odor . • Dry tongue ( thirst , Dehydration) • Shallow , deep breathing . • abdominal tenderness . • Laboratory : • RBS : > 300 mg /dl. • Hyperkalemia . • Acidosis . Hyperkalemia is most serious and can cause death

  14. Management: • Secure I.V access • Start hydration . • Monitor cardiac rhythm closely : sharp T- may need sodium bicarbonate . • Sign waves indicates Hyperkalemia and necessitates I.V ca calcium chloride or gluconate. • Insulin may be started at the hospital.

  15. pancreatitis • Definition : Acute inflammation of pancreas which is medical emergency. • Clinical presentation : • Sever abdominal pain ( epigastric or in flanks ). • Nausea , vomiting . • Abdominal distension . • Multiple organ failure (e.g. ARF ) may develop. • Management : • 1- Secure an I.V access , NPO . • 2- Management of pain , supportive care. • 3- Transport to hospital .

  16. ANY QUESTION ? THANK YOU

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