Diabetic Emergencies:Hypoglycaemia,DKA,HHS and Lactic Acidosis

Posted by e-Medical PPT Wednesday, September 15, 2010
Hypoglycemia is the state produced by a lower than normal level of blood glucose.It can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose to the brain, resulting in impairment of function (neuroglycopenia).Effects can range from vaguely feeling bad to seizures, unconsciousness, and permanent brain damage or death.The most common forms of hypoglycemia occur as a complication of treatment of diabetes mellitus with insulin or oral medications. Hypoglycemia is less common in non-diabetic persons, but can occur at any age.
Most healthy adults maintain fasting glucose levels above 70 mg/dL (3.9 mmol/L), and develop symptoms of hypoglycemia when the glucose falls below 55 mg/dL (3 mmol/L).It can sometimes be difficult to determine whether a person's symptoms are due to hypoglycemia. Criteria referred to as Whipple's triad are used to determine a diagnosis of hypoglycemia:
Symptoms known to be caused by hypoglycemia
Low glucose at the time the symptoms occur
Reversal or improvement of symptoms or problems when the glucose is restored to normal
Hypoglycemia is treated by restoring the blood glucose level to normal by the ingestion or administration of dextrose or carbohydrate foods. In some circumstances it is treated by injection or infusion of glucagon.

Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2.In Nonketotic coma a relative insulin deficiency leads to a serum glucose to increases higher than 33 mmol/l (600 mg/dl), and a resulting serum osmolarity that is greater than 350 mOsm. This leads to polyuria , which, in turn, leads to volume depletion and hemoconcentration that causes a further increase in blood glucose level.Adminisration of Intravenous fluids and Electrolyte replacement are the modes of treatment.
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