Diabetes Lecture Part 4: Acute Crises - DKA vs HHS

Overview

• Discussion about acute diabetic crises: Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS).
• Both related to high blood glucose.
• Similar treatment approaches for both conditions.
• Focus on understanding the big picture: identifying problems and treatment.

Diabetic Ketoacidosis (DKA)

• Common in Type 1 diabetics, can occur in Type 2 if pancreas is severely impaired.
• Caused by:
  • High blood glucose due to insufficient insulin.
  • Body breaks down fat, releasing ketones (acids), leading to acidosis.
• Symptoms:
  • Dehydration, high blood glucose, acidosis.
  • Kussmaul's breathing (deep, rapid breathing to expel acid).
  • Fruity smelling breath due to ketone expulsion.
• Diagnostic indicators:
  • Blood glucose > 250.
  • pH < 7.3, low bicarbonate indicating metabolic acidosis.
  • Presence of ketones in urine.
• Treatment:
  • Fluid replacement is the first priority to prevent hypovolemic shock.
  • Insulin administration to manage blood sugar levels.
  • Monitor potassium levels due to potential shifts when insulin is administered.
  • Sodium bicarbonate may be used if pH remains low after other treatments.

Hyperglycemic Hyperosmolar Syndrome (HHS)

• More common in Type 2 diabetics.
• Characterized by:
  • Severe hyperglycemia and dehydration without acidosis.
  • No ketone breakdown.
• Indicators:
  • Blood glucose > 600.
  • Increased serum osmolality.
• Symptoms:
  • Severe dehydration symptoms, changes in mental status.
• Treatment:
  • Similar to DKA but no need for acidosis treatment.
  • Focus on fluid replacement and insulin therapy.

Comparison: DKA vs. HHS

• DKA: Type 1, acidosis, ketones present, Kussmaul's respirations, lower blood glucose than HHS.
• HHS: Type 2, no acidosis, no ketones, profound dehydration, higher blood glucose.

Nursing Considerations

• Monitor level of consciousness, hydration status, and blood glucose levels.
• Watch for electrolyte imbalances, particularly potassium.
• Continuous ECG monitoring may be necessary.
• Regular laboratory checks (BMP, ABG).

Patient Improvement Indicators

• DKA: Improving blood pressure, urine output, decreasing blood glucose, improving mental status.
• HHS: Similar indicators but with a focus on mental status improvement due to higher initial blood glucose levels.

Application Questions

• Appropriate treatments and monitoring for patients with DKA and HHS.
• Prioritization of interventions based on acute treatment needs.

This concludes the acute complications segment of the diabetes lecture, focusing on DKA and HHS. Next, we will move into chronic complications associated with diabetes.