Acute Complications of Diabetes Mellitus by GerardLum

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									                                                                                                                                                 jslum.com | Medicine
Acute Complications – Diabetes Mellitus

                                                                                          Hyperglycaemic Hyperosmolar
                                               Diabetic Ketoacidosis (DKA)                Non-Ketotic Syndrome (HHNS)
           Hyperglycaemia                                                                                                                  Hypoglycaemia
                                            Absolute Insuli n Deficiency (Type I)       (Hyperosmolar Non-Ketotic Coma)
                                                                                       Relative Insulin Deficiency (Type II)
Deficient Insulin Action                   Relative Insulin Deficiency (Rare)       Characteristics                            Complication of
• ↓ Insulin Secretion                      Hyperglycaemia                           Hyperglycaemia                             Insulin Treatment (Diabetes Type I, II)
• Insulin Resistance                       Hepatic Gluconeogenesis                  Hyperosmolarity                            Oral Hypoglycaemic Drugs
Hyperglycaemia                             Glycogenolysis (2° to ↓ Insulin)         Dehydration                                (stimulate endogenous insulin
• ↓ Uptake of Glucose into Muscle,         Lipolysis                                Without Significant Ketoacidosis           secretion)(eg. Sulfonylureas, Benzoi c
  Adipose Tissue                           ↑ Free Fatty Acids                       (Insulin present – Inhibit Ketogenesis)    acid derivatives)
• Glucose stop converting to Glycogen      Free Fatty Acids → Ketone Bodies         Due to                                     Hypoglycaemia occur often
Glycosuria                                 (in Liver)                               Severe Dehydration                         Exercise
• ↑ Glucose Excee d Renal Threshold        Ketones                                  Do not Drink enough H2O to                 Fasting
  for absorption of Glucose                Acetone                                  compen sate for urinary losses             Characteristics
• Induce Os motic Diuresis                 (Fruity Breath Odour)                    (Chronic Hyperglycaemia)                   ↓ Insulin Levels
  Polyuria (loss H2O, Electrolytes)        β-Hydroxybutyrate                        Risk Factors                               ↑ Counterregulatory Hormones (slight)
                                           (Induce Nau sea, Vomiting)               Elderly Diabetic                           ↑ Blood Glucose
• Significant Loss of Calories
  (Urinary Glucose Loss > 75g/dL)          (Aggravate Fluid, Electrolyte Loss)      Disabled (eg. Stroke, Infection)           Precipitation of Hypoglycaemia
  (75g/dL x 4kCal/g = 300kCal/dL)          Acetoacetate                             Inadequate H2O intake                      Inappropriate dosing with
Polydipsia                                 Ketonemia                                Coma                                       •      Exogenous Insulin
• Dehydration                                 Early Stage         Late Stage        Caused by Hyperosmolarity                  •      Induction of En dogenous Ins ulin
• Stimulate Thirst Center                     Buffer (H CO3-)     Ketonuria         Severe loss of ICF in Brain                Acute Response to Hypoglycaemia
Polyphagia                                                        Ketoacidosis      Effective Plasma Osmolarity reaches        ↑ Glucagon
• Protein, Fat Catabolism                                         Kussmaul          340mOsm/ L (280 -295mOsm/L)                ↑ Catecholamines
• Negative Energy Balance                                         Respiration       Delay in seeking Medical Attention         Acute Treatment of Hypoglycaemia
                                                                  (Deep Rapid       Absence of Ketoacidosis                    Rapid Oral Glucose
Clinical
                                                                  Breathing)        Absence of Symptoms (Na usea,              Intravenous Glucose
Polyuria, Polydipsia, Polyphagia
                                                                                    Vomiting, Respiratory Difficulties)        Intramuscular Glucagon
Weight Loss (dehydration, calories loss)
                                           Hypokalaemia                             Mild Ketonuria can occur                   Somogyi Phenomenon
Blurred Vision
                                                             Due to                 If Patient has not been eating             Rebound Hyperglycaemia
(change of H2O content of lens of eyes)
                                             Acidosis, Insulinopenia, ↑ Glucose     K+ Loss                                    Due to actions of counter regulatory
Impair                                                        ↓                     ↓ Severe than Diabetic Ketoacidosis        hormones
Neutrophil Chemotaxis, Phagocytosis                      K+ shift from                                                         Aggravated by Excessive Glucose
       Women                 Men                 Intracellular → Extracellular
  Candidal             Candidal                                                                                                Initial Catecholamine Symptoms
                                            (to exchange with H+ due to Acidosis)
                                                                                                                               Sweating, Weakness, Anxiety,
  vulvovaginitis       balanitis                    (to maintain K+ levels)
                                                              ↓
                                                                                                                               Faintness, Shakiness, Tremor,
                                                Extracellular K+ is lost in Urine                                              Palpitations, Tachycardia
                                                   (due to Osmotic Diuresis)                                                   Neuroglycope nic Symptoms
                                           Dilutional Hyponatraemia                                                            Confusi on, Irritability, Headaches,
                                           Due to ↑ Serum Osmolarity                                                           Abnormal Behaviour, Diplopia, Motor
                                           (Water Intracellular → Extracellular)                                               Incoordination, Coma, Weakness,
                                           Loss of Sodium in Urine                                                             Convulsion
                                           During Osmotic Diuresis                                                             Nocturnal Hypoglycaemia
                                                                                                                               Morning Headaches lassitude night
                                                                                                                               sweat nightmares
                                                                                                                               Difficulty in awakening, Psychologic
                                                                                                                               changes
                                                                                                                               Restlessness during Sleep
                                                                                                                               Loudness Respirations

								
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