ACUTE COMPLICATION OF DM

CLINICAL MANIFESTATION
LABORATORY PROCEDURES
THERAPEUTIC PLAN
POSSIBLE PROBLEM ASSOCIATED
Acute Complication of DM
Comprises 2 condition:
Diabetic Ketoacidosis (DKA) primarily seen
in type 1 DM
Hyperglycemin Hyperosmolar State (HHS)
primarily seen in type 2 DM
Both disorder associated w/:
Absolute or relative insulin deficiency
Volume depletion
Acid-base abnormalities
Serious complication if not promptly
diagnosed or treated
Diabetic Ketoacidosis (DKA)
Primarily found in type 1 DM
Associated with acidosis and ketosis
Characteristics:
Hyperglycemia
Ketosis
Metabolic acidosis
Precipitated by:
Inadequate insulin administration
Infection Pneumonia, UTI, Gastroenteritis, Sepsis
Infarction Cerebral, Coronary, Mesentery,
Peripheral
Drugs cocaine
Pregnancy
 Pathophysiology of DKA
Relative or absolute Counterregulatory
insulin deficiency hormone action

Disturbance in Disturbance in lipid

glucose metabolism metabolism

Glucose overproduction Excess conversion of FFA

to acetyl-coA than use

Accumulation of Ketone bodies

Hyperosmolarity Glycosuria

Osmotic diuresis Ketonemia & Severe acidosis

Hypovolemia

Tissue hypoxia lactic Ketonuria

acidosis production
Decrease cerebral blood Tachypnea
flow coma
Hyperviscosity - thrombosis
Hyperglycemic Hyperosmolar State
(HHS)
Primarily found in DM type 2 and older patient
Clinical pictures:
Hyperosmolarity (>320 mOsm/L)
Hyperglycemia (> 600 mg/dL)
Dehydration
Precipitated by:
Serious, concurrent illnesses MI
Sepsis, Pneumonia, and other serious infection
Debilitating conditions Stroke or dementia
Condition compromising water intake
Patient feature:
Old age
Mental status changes
Accompanying co morbidities condition
Pathophysiology of HHS
Inadequate fluid intake Relative insulin
deficiency

Hepatic glucose production

Impairs glucose utilization in periphery

Hyperglycemia

Osmotic diuresis

Intravascular volume depletion

Mental convulsion, lethargy, coma

CLINICAL MANIFESTATION
DKA HHS
Several week
Onset Develops over 24 history of
h polyuria, wt loss
and diminished
oral intake
Nausea & vomiting
Thirst/Polyuria
Abdominal
pain/tenderness
Dyspnea
Tachycardia
Dry mucous membrane
Dehydration/hypovolemia
Tachypnea/kussmauls
breath
LABORATORY PROCEDURE
THERAPEUTIC PLAN
Volume depletion and hyperglycemia are
prominent features of both complications
Consequently, the management for both
share the several elements
Crucial:
Careful monitoring of fluid status
Laboratory values
Insulin infusion rate
Fluid Loss:
DKA 3-5 L
HHS 9-10 L
THERAPEUTIC PLAN
POSSIBLE PROBLEM
ASSOCIATED
Most common complication of DKA is
cerebral edema from hypervolemia
Hypokalemia may lead to cardiac arrest
Hypoglycemia from insulin administration