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Diabetic Emergencies (Hypoglycemia (Diabetic (Causes: Iatrogenic (too…

- - - - Manage:
        
        Coma? :warning: emergency:
        give IV Glucose load :candy::candy::candy:
        
        D50
        
        Awake? Give oral glucose load. :candy:
        
        pixie sticks, jelly beans
        
        recheck until return to normal
        
        :pencil2:Pt usually knows s/s:
        
        Palpitations :two_hearts:
        
        Diaphoresis :sweat_drops:
        
        Presyncope
        
        progression to Coma :sleeping_accommodation::skin-tone-2:
        
        Dx: blood Glucose <70
        Tx: Correct w/ glucose
        F/u: find out cause
        
        lower Rx
        
        counseling
        
        :pencil2:(some pts may tolerate <70, some may experience s/s @ >70, still hypoglycemia, needs correcting)
  - - - Dx: Wait until hypoglycemic
        
        C peptide
        
        Proinsulin
        
        Secretagogue screen
        
        C peptide elevated?
        
        :green_cross: No, Factitious :checkered_flag:
        
        injecting insulin
        
        tell pt to stop wasting my time
        
        :check: Yes, endogenous production
        Secretagogue screen (sulfonureas :egg:)
        
        :check: Sulfonurea positive, Factitious :checkered_flag:
        
        tell pt to stop wasting my time
        
        :green_cross: no sulfonureas
        Suspect Insulinoma
        
        72 hr fast, inpatient
        
        CT MRI to find tumor
        
        :checkered_flag:Inslinoma
- - - - Pt: Diabetic coma/AMS :sleeping_accommodation::skin-tone-2:
        
        Ketones w/ Acidosis
        
        Dx: confirm, then send to ICU
        
        blood glucose >300-500
        
        UA: positive ketones (good initial)
        
        blood/serum: Ketones ( :stars: Best test)
        
        ABG: Acidosis
        
        BMP: see Gap, see K
        
        Tx: DKA protocol
        
        Potassium :banana:
        :warning: need to check K before correcting glucose, otherwise crashes K
        
        K must be above 4
        
        replace K whenever it drops below 4, using BMP
        
        Glucose
        
        Insulin 10U IV
        
        then Insulin drip
        
        checking blood glucose while doing
        
        Anion Gap
        
        Gap is fixed by insulin
        
        Fix dehydration: bolus, vigorously : saline or lactated ringers :ocean:
        
        Follow Gap w/ BMP
        
        dr price: correct fluids first then get VBG
        then close electrolyte gap and BG w insulin
        5:5, 5 L down at the door, 5U/hr volume resuscitation
        
        1 more item...
  - - - Pt: Diabetic coma :sleeping_accommodation::skin-tone-2:
        
        but :forbidden:no ketones
        
        :forbidden:no Acidosis
        
        Dx: Blood glucose 800-1000
        
        UA: no ketones
        
        ABG: no acidosis
        
        BMP: K, no Gap
        
        Tx: Same as DKA (fluids :droplet:)
        
        fluids :ocean: & IV insulin