DIRECT CHOLINERGIC DRUGS Profs. Abdalqader Alhaider & Hanan Hagar Pharmacology Unit.
Management of diabetic ketoacidosis and hypoglycemia Prof. Hanan Hagar.
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Transcript of Management of diabetic ketoacidosis and hypoglycemia Prof. Hanan Hagar.
![Page 1: Management of diabetic ketoacidosis and hypoglycemia Prof. Hanan Hagar.](https://reader030.fdocuments.us/reader030/viewer/2022033020/56649e355503460f94b23385/html5/thumbnails/1.jpg)
Management of diabetic ketoacidosis
and hypoglycemiaProf. Hanan
Hagar
![Page 2: Management of diabetic ketoacidosis and hypoglycemia Prof. Hanan Hagar.](https://reader030.fdocuments.us/reader030/viewer/2022033020/56649e355503460f94b23385/html5/thumbnails/2.jpg)
Diabetic ketoacidosis
Is a serious acute emergency situation that requires admission to hospital with a risk of death.
It is a complication of diabetes (a characteristic feature of type I diabetes but may occurs with type II especially during stress).
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Causes of diabetic ketoacidosis
It develops as a result of insulin deficiency and increased amounts of counter-regulatory hormones.
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Diabetic ketoacidosis
In absence of insulin, many metabolicchanges occur:Carbohydrates– ↑ glycogenolysis, ↑ gluconeogenesis
Protein– ↑ proteolysis thus providing amino acid
as precursors for gluconeogenesis. (hyperglycemia)
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Diabetic ketoacidosis
Fats
– ↑ Fat breakdown to free fatty acids then to acetyl-CoA that is converted to acetoacetic acid and β-hydroxybutyric acid and acetone (ketone bodies).
(ketonemia, ketonuria & metabolic acidosis).
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Diabetic ketoacidosis
– Hyperglycemia-induced → glycosuria → osmotic diuresis & severe fluid loss.
– Fluid loss → dehydration & electrolyte imbalance
– Metabolic acidosis induces hyperventilation
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↑ glycogenolysis↑ gluconeogenesis, ↑ protein catabolism↑ Lipolysis
↑ Hyperglycemia
Glycosuria
Osmotic diuresis
Dehydration
↓
↓
↓
↓
Diabetic ketoacidosisInsulin deficiency
↑ Lipolysis
↑ Free fatty acids
↓
↓↑ Ketone bodies
(ACAC, β-OHB, Acetone)
Ketonemia↓
↓
Ketonuria & Acidosis
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Characters of diabetic ketoacidosis
• Hyperglycemia
• Glycosuria
• Osmotic diuresis
• Polyuria
• Thirst
• Polydipsia (increased drinking).
• Dehydration
• Electrolyte imbalance
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Characters of diabetic ketoacidosis
• Ketogenesis (Ketonemia, Ketonuria)
• Metabolic acidosis
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Diagnostic Criteria in diabetic ketoacidosis
• Blood glucose > 250 mg/dl
• pH < 7.35
• HCO3 < 15 mEq/L
• Ketonemia
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Precipitating factors for diabetic ketoacidosis
InfectionsMissed insulin treatments Newly diagnosed diabetes.Use of medications: as steroids, thiazide
diuretics.Trauma, Stress, Surgery
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Clinical symptoms for diabetic ketoacidosis
Classic features of hyperglycemia– Thirst, polyuria
Vomiting/abdominal painKetotic breath (fruity, with acetone smell)ConfusionComa
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Lines of treatment of diabetic ketoacidosis
Adequate correction of :– Dehydration (fluid therapy)– Hyperglycemia (insulin)– Electrolyte deficits (potassium therapy)– Ketoacidosis (bicarbonate therapy)
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Treatment of diabetic ketoacidosis
Fluid therapy (Rehydration)– Infusion of isotonic saline (0.9% sodium
chloride) at a rate of 15–20 mL/kg/hour to restore blood volume and renal perfusion.
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Treatment of diabetic ketoacidosis
Insulin therapy (Short acting insulin)– Regular insulin, should be administered
by means of continuous intravenous infusion in small doses through an infusion pump (0.1 U/kg/h).
– Insulin stops lipolysis and promotes degradation of ketone bodies.
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Treatment of diabetic ketoacidosis
Potassium therapy– potassium replacement must be initiated.– potassium is added to infusion fluid to
correct the serum potassium concentration.
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Treatment of diabetic ketoacidosis
Bicarbonate therapy– bicarbonate therapy should be used
Only if the arterial pH < 7.0 after 1 hour of hydration, (sodium bicarbonate should be administered in every 2 hours until the pH is at least 7.0).
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Hypoglycemia
Is a life threatening disorder that occurs when blood glucose level becomes < 50 mg/dl.
One of the common side effects of insulin in
treating type I diabetes.
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Causes of Hypoglycemia
– Overdose of insulin or oral hypoglycemic drugs (sulfonylurea - meglitinides).
– Excessive physical exercise– Missed or delayed meal.– Drug-induced hypoglycemia.
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Causes of Hypoglycemia
– Hypoglycemia can be an early manifestation of other serious disorders (sepsis, congenital heart disease, brain hemorrhage).
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Characters of Hypoglycemia
Autonomic features
sympathetic: tachycardia, palpitation,
sweating, anxiety, tremor.
parasympathetic: nausea, vomiting.
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Characters of Hypoglycemia
Neurological defects: – Headache, visual disturbance, slurred
speech, dizziness.– Tremors, mental confusion, convulsions.– Coma due to blood glucose to the brain.
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Precautions
Hypoglycemia can be prevented by:Blood sugar level should be checked
routinely (blood sugar of less than 70 mg/dl is considered hypoglycemia).
Patients should carry glucose tablets or hard candy to eat if blood sugar gets too low.
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Precautions
Diabetic patient should wear a medical ID bracelet or carry a card.
Patient should not skip meals or eat partial meals.
Eat extra carbohydrates if he will be active than usual.
Check your blood sugar more often when you are exercising more.
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Conscious patient:– Sugar containing beverage or food (30 g
orally).
Unconscious patient:– Glucagon (1 mg S.C. or I.M.)– 20-50 ml of 50% glucose solution I.V.
infusion (risk of possible phlebitis).
Treatment of Hypoglycemia
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Hypoglycemic coma Hyperglycemic coma
Diabetic ketoacidosis
Onset Rapid Slow - Over several days
Insulin Excess Too little
Acidosis & dehydration
No Ketoacidosis
B.P. Normal Subnormal or in shock
Respiration Normal or shallow air hunger
Skin Pale & Sweating Hot & dry
CNS Tremors, mental confusion, sometimes convulsions
General depression
Blood sugar Lower than 70 mg/100cc
Elevated above 200 mg/100cc
Ketones Normal Elevated
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SUMMARY
• Hyperglycemic ketoacidosis: is treated by insulin, fluid therapy, potassium supplementation and bicarbonate.
• Hypoglycemia: is treated by oral tablets, juice or honey (if patient is conscious) and by glucagon (1 mg S.C. or I.M.) or 20-50 ml of 50% glucose solution I.V. infusion (if patient is unconscious).