Exhaled ketone bodies produce nail-polish remover or fruity breath odor
14 Diabetic Ketoacidosis
Ketone body production (ketoacidosis)
15 Hyperosmolar Coma
Usually Type II diabetic (inadequate insulin)
Blood sugar rises
Kidneys try to remove excess sugar
Urine production increases (polyuria)
Patient becomes volume depleted
Dry skin mucous membranes
16 Hyperosmolar Coma
Cells continue to burn sugar
Acidic ketone bodies not produced
Nail-polish remover or fruity breath odor not present
17 Hyperosmolar Coma
Severe volume depletion
NO ketone body production
Treat for hypovolemic shock
When in doubt give sugar!
Normal insulin use without eating
20 Hypoglycemia Pale cool skin sweating nausea tachycardia Is that why hypoglycemia sometimes is called Insulin Shock 21 Hypoglycemia
Insulin shock isnt really shock
Patient just looks shocky because of epinephrine adrenals are releasing
Can occur in non-diabetics
Most common cause EtOH on empty stomach
A patient is never just drunk
23 Hypoglycemia Management
Give sugar orally
Get ALS back-up for IV glucose
When in doubt Give Sugar!
24 Ask All Diabetics
Have you eaten today
Have you taken your medication today
When in doubt give Sugar!
25 Other Diabetes Complications
Peripheral vascular disease
26 Other Diabetes Complications
Increased silent myocardial infarction risk
27 Silent MI
Acute MI in diabetic can present without chest pain
May resemble flu
Manage sick diabetics as if critically ill until proven otherwise
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