Metabolic emergencies in diabetes.
Hypoglycaemia is the commonest metabolic abnormality faced by diabetic patients on hypoglycaemic therapy including insulin. Diabetic keto-acidosis (DKA) requires prompt diagnosis and all patients arriving emergency with dehydration, shock, coma, severe respiratory difficulty and evidence of any major illness should be tested for capillary blood glucose (CBG) and urinary ketones urgently not to miss DKA. Hyperosmolar non-ketotic state complicates elderly type 2 diabetes with intercurrent infections (respiratory tract infection is commonest) characterised by severe dehydration, severe hyperglycaemia and absence of acidosis and vomiting. Lactic acidosis is extremely rare; may be compounded with comorbidities like tissue hypoxia, septic shock, heart failure--metformin usage inadvertently may precipitate the condition.
Mukherjee
Apurba Kumar
AK
Department of Medicine, RG Kar Medical College, Kolkata.
Chowdhury
Manash Bhanja
MB
D000140:Acidosis, Lactic / Q000175:diagnosis / Q000628:therapy; D048909:Diabetes Complications / Q000175:diagnosis* / Q000628:therapy; D003920:Diabetes Mellitus / Q000175:diagnosis*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000628:therapy; D004630:Emergencies; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000628:therapy; D007328:Insulin / Q000172:deficiency; D008659:Metabolic Diseases / Q000175:diagnosis* / Q000628:therapy
D007328:Insulin