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Diabetes and Hypertension Complications
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Diabetes and Hypertension Complications
Diabetes and Hypertension Complications
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1
Question
What are acute and chronic complications related to?
Answer
Diabetes and hypertension.
2
Question
List the objectives related to diabetes mellitus and hypertension complications.
Answer
1. Chronic complications of diabetes mellitus. 2. Acute metabolic: hypoglycemia / diabetic ketoacidosis. 3. Fundus. 4. Foot examination: micro / macrovascular / neuropathy. 5. Hypertensive urgency vs emergency. 6. Chronic complications of arterial hypertension.
3
Question
What are the acute metabolic complications?
Answer
Hypoglycemia and diabetic ketoacidosis.
4
Question
What is diabetic ketoacidosis characterized by?
Answer
Hyperglycemia and ketoacidosis.
5
Question
What is the second most common presentation related to?
Answer
Diabetic ketoacidosis.
6
Question
What are the symptoms of diabetic ketoacidosis?
Answer
Poliuria, polydipsia, weight loss, sweet breath, dizziness, lethargy, nausea, and anorexia.
7
Question
List the precipitating factors of diabetic ketoacidosis.
Answer
Infections, poor glycemic control, acute diseases (MI, stroke, sepsis), new-onset DM1, drugs that alter carbohydrate metabolism, SGLT2 inhibitors, and cocaine.
8
Question
What is the pathophysiology behind diabetic ketoacidosis related to?
Answer
Insufficient or absent insulin leading to increased glucagon, muscle cells producing amino acids, and fat cells producing glycerol and fatty acids, all contributing to increased ketone and glucose production.
9
Question
What are the hormones involved in clinical diabetic ketoacidosis?
Answer
Glucagon, cortisol, catecholamines, and growth hormone.
10
Question
What are the consequences of glucagon increase in diabetic ketoacidosis?
Answer
Increased lipolysis leading to increased free fatty acids, increased ketogenesis, decreased alkaline reserve, cetoacidosis, and lactic acidosis.
11
Question
What are the consequences of cortisol increase in diabetic ketoacidosis?
Answer
Decreased glucose utilization, increased proteolysis leading to increased gluconeogenic substrates, increased gluconeogenesis, and hyperglycemia.
12
Question
What are the consequences of growth hormone increase in diabetic ketoacidosis?
Answer
Increased glycogenolysis, leading to hyperglycemia.
13
Question
What is the effect of hyperglycemia in diabetic ketoacidosis?
Answer
Glucosuria (osmotic diuresis), leading to water and electrolyte loss, dehydration, and hyperosmolarity.
14
Question
What can dehydration lead to in diabetic ketoacidosis?
Answer
Altered renal function.
15
Question
What are the metabolic complications of diabetes?
Answer
Diabetic ketoacidosis, hypoglycemia (40% ≥1 episode), and hyperglycemic hyperosmolar state (>DM2).
16
Question
Describe diabetic ketoacidosis (DKA).
Answer
It is a metabolic emergency more common in DM1, characterized by hyperglycemia, metabolic acidosis, and ketosis, often due to a relative or absolute insulin deficiency plus an increase in counter-regulatory hormone levels.
17
Question
List the precipitating factors for DKA.
Answer
New onset, insulin omission, infection, myocardial infarction, and physiological stress.
18
Question
What are the complications of untreated DKA?
Answer
Hyperkalemia, shock, lactic acidosis, and rhabdomyolysis.
19
Question
What are the complications of DKA treatment?
Answer
Cerebral edema, hypokalemia, and hypoglycemia.
20
Question
What is included in the initial evaluation of Diabetic Ketoacidosis (DKA)?
Answer
Initial tests include glucose, ketones, electrolytes, ABG/VBG, BUN, Cr, CBC, anion gap and NA correction, urinalysis, ECG.
21
Question
What are the goals of Diabetic Ketoacidosis (DKA) management?
Answer
Restore intravascular volume, prevent or correct electrolyte abnormalities, correct acidosis and hyperglycemia.
22
Question
How is fluid and electrolyte administered during DKA management?
Answer
Fluids are the 1st line of treatment → 0.9% saline initially → normal or high serum NA = 0.45% saline at 250-500 ml/h → low serum NA = 0.9% saline at 250-500 ml/h. HCO3: ADA pH <6.9, 100 mEq in 400 ml sterile H2O + 20 mEq KCl x 2 hours → Every 2 hours. Replace potassium. Replace magnesium if serum magnesium <1.2 mg/dl or with symptoms.
23
Question
How is insulin administered for DKA management?
Answer
In severe CAD, anasarca, or hypotension, administer insulin. Subcutaneous insulin can be used in alert patients who tolerate oral intake, pH >7, bicarbonate ≥ 10 mEq/L. Basal insulin is used in patients with recent diagnosis or those already using this insulin.
24
Question
What happens to glucose in the absence of insulin?
Answer
Without insulin, blood glucose cannot enter the cell and be used as energy in our body.
25
Question
What is the result of glucose accumulation in the blood?
Answer
Its accumulation in the blood is called 'hyperglycemia'.
26
Question
What happens when the body experiences chronic hyperglycemia?
Answer
Faced with chronic hyperglycemia, the body needs another source of energy to function.
27
Question
What does the body use as an alternative energy source and what does it lead to?
Answer
The body begins to use fat reserves as an energy source, which leaves 'ketones' in the blood.
28
Question
What are the consequences of ketones in the blood?
Answer
This can lead to 'diabetic ketoacidosis', where the pH of the blood changes to acidic and affects the function of the body.
29
Question
What levels of glucose suggest the need for ketone level check?
Answer
With a glucose above 240mg/dl and/or symptoms, check your levels of ketones in blood (recommended) or urine.
30
Question
What should someone do if they test positive for ketones?
Answer
Contact your doctor, correct the hyperglycemia, do not exercise, check your ketone level every hour, and take water and electrolytes.