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Acute Complication of Diabetes Mellitus

Hyperglycemia crisis
Diabetic ketoacidosis (DKA) Hyperglycemic Hyperosmolar State (HHS)


Diabetic Ketoacidosis (DKA)

DKA merupakan karakteristik dari DM tipe 1
The symptoms and physical signs of DKA
Symptoms : Nausea/vomiting, Thirst/polyuria, Abdominal pain, Shortness of breath. Physical findings : Tachycardia, Dry mucous membranes/reduced skin turgor, Dehydration / hypotension, Tachypnea / Kussmaul, respirations/respiratory distress, Abdominal tenderness (may resemble acute pancreatitis or surgical abdomen), Lethargy /obtundation / cerebral edema / possibly coma

Precipitating factors
Kekurangan Insulin Infeksi(pneumonia/Gastroenteritis/se psis) Infarction (cerebral, coronary, mesenteric, peripheral) Obat-obatan (cocaine) kehamilan

Hyperglycemic Hyperosmolar State (HHS)

Extreme hyperglycemia Severe dehydration without significant ketosis or acidosis Tachycardia Low grade fever Low or normal blood pressure Dehydration dry mucous membrane, absent axillary sweat, poor skin turgor. Nausea, vomiting, distension, and paingastroparesis is due to hypertonicity Lethargy, hallucinations, and psychosis

Perbedaan HHS dan DKA

l Patients usually older- typically 60 or more l Major pathophysiologic differences l longer uncompensated osmotic diuresis l greater volume depletion l Acidemia (pH > 7.3) and ketosis are mild l Higher mortality l often 30-50% l primarily due to underlying vascular or infectious event l Occurs in Type 2 diabetics, often mild or unrecognized


Hypoglycemia adalah keadaan gula darah berada di bawah normal yang dapat menyebabkan disfungsi dari CNS. Hypoglycemia: BG <50 mg/dL in men; <45 mg/dL in women

Faktor Hipoglikemi
Missed or delayed meal Eating less food at a meal than planned Vigorous exercise without carbohydrate compensation Taking too much diabetes medicine (e.g., insulin, insulin secretagogues, and meglitinides) Drinking alcohol

Signs of Hypoglycemia
Mild Hypoglycemia:
Pallor, Diaphoresis, Tachycardia, Palpitations, Hunger, Paresthesias, Shakiness Individual is able to self-treat

Moderate Hypoglycemia
Inability to Concentrate, Confusion, Slurred Speech, Irrational or uncontrolled behavior, slowed reaction time, blurred vision, somnolence, extreme fatigue Individual is able to self-treat

Signs of Hypoglycemia
Severe Hypoglycemia
Completely automated/disoriented behavior Loss of Consciousness Inability to arouse from sleep Seizures Individual requires assistance of another person

Requirements for Diagnosis

Whipples Triad
Symptoms of hypoglycemia Blood glucose levels <50 mg/dL in men or <45 mg/dL in women Alleviation of symptoms after correction of the low BG levels (ingestion of sugar)