Chapter Goal. Learning Objectives 9/12/2012. Chapter 25. Diabetic Emergencies

Transcription

1 Chapter 25 Diabetic Emergencies Chapter Goal Use assessment findings to formulate field impression & implement treatment plan for patients with diabetic emergencies Learning Objectives Describe pathophysiology of diabetes mellitus Describe effects of decreased or increased levels of insulin Discuss management of diabetic emergencies Discuss pathophysiology of hypoglycemia Recognize signs & symptoms of patient with hypoglycemia 1

2 Learning Objectives Describe management of hypoglycemic patient Integrate pathophysiological principles & assessment findings to formulate field impression & implement treatment plan for patients with hypoglycemia Discuss pathophysiology of hyperglycemia Learning Objectives Describe mechanism of ketone body formation & its relationship to ketoacidosis Recognize signs & symptoms of patient with hyperglycemia Describe management of hyperglycemic patient Differentiate among diabetic emergencies on basis of assessment & history Learning Objectives Correlate abnormal findings in assessment with clinical significance in patients with diabetic emergencies Develop patient management plan based on field impression in patients with diabetic emergencies 2

3 Diabetes and Insulin Chronic disease of endocrine system Cause Secretion or activity of insulin Diabetes and Insulin Movement of glucose into cell Diabetes and Insulin Glucagon secretion 3

4 Diabetes and Insulin Classifications: Type 1 Insulin dependent Typically, onset in young people Require insulin administration Type 2 Non-insulin dependent Onset usually after teenage years May or may not require insulin administration Diabetes and Insulin Complications: Eye disease Kidney disease Nerve disease Risk for CV disease Hypoglycemia Causes Medications Excessive exercise Endocrine disease Alcohol consumption Poor diet Hypothermia Liver disease In diabetic patient, takes insulin without enough food 4

5 Hypoglycemia Patient assessment Develops rapidly Altered LOC Shakiness, weakness Diaphoresis Tachycardia, tachypnea Slurred speech Neurological deficit (unusual) Seizures (common in children; unusual in adults) Hypoglycemia: Use of Glucometer Clean finger with alcohol wipe Pierce finger with lancet Hypoglycemia: Use of Glucometer Use pipette to obtain blood sample (depends on glucometer) Obtain blood sample 5

6 Hypoglycemia: Use of Glucometer Blood glucose reading Hypoglycemia Emergency care Control airway; assist breathing if necessary Administer O 2 Monitor ECG Conscious patient: administer sugar If symptoms moderate to severe (per local protocol): Initiate IV in large vein Draw blood sample Administer 50% dextrose If unable to establish IV, consider glucagon Transport to appropriate hospital without delay Provide psychological support Hypoglycemia Administration of thiamine (vitamin B1) Thiamine deficiency can produce: Wernicke s syndrome Acute, reversible Unsteady gait Eye muscle weakness Mental derangement Korsakoff s psychosis May be irreversible Significant memory disorder If patient malnourished or alcoholic, administer thiamine (IV or IM) before administering 50% dextrose 6

7 Hyperglycemia & DKA Hyperglycemia Blood glucose level above normal Most common cause diabetes Common symptoms: Polyuria Polydipsia Blurred vision possible Diabetic ketoacidosis (DKA) Complication of diabetes Consists of hyperglycemia, dehydration, accumulation of ketones & ketoacids Hyperglycemia & DKA Pathophysiology of DKA Hyperglycemia & DKA Causes of DKA Most common infection Patient assessment Slow onset Weakness Nausea, vomiting Abdominal pain Polyuria Thirst Kussmaul respirations Altered LOC Possibly fruity, acetone-like odor to breath Normal or BP Rapid, weak pulse 7

8 Hyperglycemia & DKA Emergency care Maintain airway, assist breathing Administer high-concentration O 2 Monitor ECG Initiate IV; administer fluid bolus per local protocol Watch for shock Give nothing by mouth Transport to appropriate hospital without delay Provide psychological support Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC) Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC) Common cause of hyperglycemia & altered LOC Typically, patient is: >60 yrs of age Poor health Often in nursing home or assisted living Precipitated by infection, cold, or dehydration Gradual (over 4-5 days) deterioration of mental status Treatment Same as for DKA, initially IV administration of normal saline 8

9 General Management of Any Diabetic Emergency Provide care based on clinical assessment Maintain ABCs Finger stick blood glucose History Has insulin dose changed recently? Has patient missed any meals? Has patient had recent infections? Has patient suffered any psychological stress? Has patient had change in frequency of urination? General Management of Any Diabetic Emergency Physical assessment Altered mental status Kussmaul respirations Tachycardia Hypotension Fruity breath odor Skin color & temperature Hydration status General Management of Any Diabetic Emergency General guidelines Manage airway with supplemental O2; assist ventilation, intubate if necessary Per local protocols, draw blood sample; determine blood glucose reading Monitor vital signs, ECG Administer 50% dextrose per local protocol 9

10 Summary Diabetes disease of the endocrine system resulting from a lack of insulin Hypoglycemia state of low blood glucose Care for the conscious hypoglycemic patient sugar should be given Summary Care for unconscious patient per local protocols Hyperglycemia is elevation of blood glucose levels Diabetic ketoacidosis is abnormal metabolic condition resulting in hyperglycemia & accumulation of ketones & ketoacids in blood Questions? 10