METABOLIC

EMERGENCIES
Presented by:
John Micky Rey D. Tado
 DEFINITION
Metabolic emergencies are
characterized by severe metabolic
process abnormalities. These
imbalances frequently call for rapid
medical attention and have the
potential to be fatal
EXAMPLES:
• Diabetic Ketoacidosis
• Hyperglycemic
Hyperosmolar State
• Hypoglycemia
• Hypercalcemia
• Hyperkalemia
• Hyponatremia
 CAUSES
There are several underlying causes of metabolic
emergencies:
• Diabetic Ketoacidosis - Occurs in individuals with
diabetes, typically when their blood sugar levels become
very high (hyperglycemia)
• Hypoglycemia - This can result from an overdose of
insulin or oral diabetes medications, inadequate food
intake, or excessive physical activity
• Acute Liver Failure - When the liver is unable to perform
its metabolic functions, it can lead to a buildup of toxic
substances in the body
• Trauma and Burns - Severe physical trauma or burns can
disrupt the body's metabolic balance, leading to
metabolic emergencies such as shock and fluid
imbalances
• The body doesn't have the right enzyme to break down
certain types of foods, like fats, proteins, or
carbohydrates
• One of the organs involved in metabolism is diseased or
damaged
RISK FACTOR
• Diabetes
• Obesity
• Chronic kidney disease
• Liver disease
• Alcohol and drug abuse
• Starvation or fasting
• Trauma or surgery
• Pregnancy
 PATHOPHYSIOLOGY
• Alteration in Metabolism
• Hyperglycemia - DKA starts with elevated blood sugar levels brought on by a
lack of or insufficient insulin activity.
• Insulin Deficiency - DKA is an insulin shortage, which can happen in people with
type 1 diabetes or when insulin therapy is insufficient.
• Increased Lipolysis - Cells in the body are unable to efficiently absorb glucose for
energy if there is insufficient insulin present. In order to make up for this, the
body starts converting stored fat into free fatty acids.
• ↑ Free Fatty Acids - Free fatty acid levels in the blood increase as a result of
increased lipolysis.
• Ketone Production - These extra fatty acids are converted by the liver into
ketones, particularly beta-hydroxybutyrate and acetoacetate.
• Ketone Accumulation - Ketonemia is a medical disorder that results from an
accumulation of ketones in the blood.
• Metabolic Acidosis - Metabolic acidosis results from the buildup of ketones in
the blood, which lowers the blood pH.
• Clinical Symptoms - Clinical symptoms of metabolic acidosis and increased
ketone levels include dehydration, disorientation, excessive thirst, and frequent
urine (polyuria)
Signs and Symptoms
• Unintended weight loss, or a failure to gain
weight and grow in babies and children
• Unexpected weight gain
• Tiredness and lack of energy
• Changes to the skin – color, bruising easily,
thinning, slow to heal
• Belly pain and vomiting
• Decreased appetite
• Feeling hungry and thirsty, even though you
are eating
• Developmental delays in babies and children-
they don’t reach milestones when they are
supposed to
 DIAGNOSTIC TEST AND
INTERPRETATION
• Blood Glucose Levels : To measure blood glucose levels
• Interpretation : Below 70 (hypoglycemia) and above 180mg/dL (hyperglycemia)
• Arterial Blood Gas : Measures the levels of oxygen and carbon dioxide in the blood, as
well as blood pH and bicarbonate levels
• Interpretation : ABG results can help assess acid-base balance and respiratory status
• Serum Electrolyte Levels : To measure levels of electrolytes, including sodium, potassium,
calcium, and magnesium
• Interpretation : Abnormalities in electrolyte levels can indicate metabolic disturbances
• Urine Analysis : Detect glucose, ketones, and other substances in the urine
• Interpretation : Presence of glucose in urine may indicate uncontrolled diabetes
• Thyroid Function Test : Measures thyroid hormone levels, including TSH, T3
(triiodothyronine), and T4 (thyroxine)
• Interpretation : Abnormal thyroid function can lead to metabolic abnormalities and may
require further investigation
• Liver Function Test : Blood tests assess liver enzymes, bilirubin, and other markers of liver
function
• Interpretation : Abnormal liver function can affect metabolism and may be a sign of liver
disease or dysfunction
• Genetic Testing : To identify specific genetic mutations associated with metabolic
disorders
• Interpretation : Genetic testing can provide a definitive diagnosis for some metabolic
emergencies
 TREATMENT
• Diabetic Ketoacidosis
-Monitor blood glucose and electrolyte levels regularly
-Insulin therapy to lower blood sugar levels
-Administer intravenous (IV) fluids to correct dehydration
and electrolyte imbalances
• Hypoglycemia
-Identify and address the underlying cause of
hypoglycemia, such as excessive insulin or inadequate food intake
-Administer a rapidly absorbed source of glucose, such
as oral glucose gel or intravenous dextrose
• Hypercalcemia
-Treat the underlying cause, which may include
hyperparathyroidism, cancer, or excessive vitamin D intake
-Administer IV fluids to promote diuresis and help lower
calcium levels
• Hyperkalemia
-Administer calcium gluconate or calcium chloride to
stabilize cardiac cell membranes
-Hemodialysis may be necessary for severe cases
• Hyponatremia
-Correct the underlying cause, such as syndrome of
inappropriate antidiuretic hormone (SIADH) or excessive water intake
NURSING DIAGNOSIS
• Acute Pain
• Impaired Gas Exchange
• Fluid Volume Deficit
• Impaired Skin Integrity
• Imbalanced Nutrition
• Knowledge Deficit
• Risk for Electrolyte Imbalance
• Risk for Infection
 NURSING MANAGEMENT
• Assess and Monitoring : Start with a thorough assessment,
including vital signs and Assess the patient's mental status,
neurological signs, and level of consciousness using standardized
tools like the Glasgow Coma Scale
• Stabilization : Maintain a patent airway and ensure adequate
oxygenation and ventilation
• Fluid Management : Administer intravenous fluids as prescribed
to correct dehydration and maintain electrolyte balance
• Nutritional Support : Monitor dietary intake, especially in
patients with diabetic emergencies
• Medication Administration : Administer insulin as prescribed for
hyperglycemic emergencies while closely monitoring blood
glucose levels
• Managing Respiratory Compensations : Monitor respiratory rate,
depth, and effort to identify changes indicative of compensatory
mechanisms and Administer oxygen therapy as needed to
support respiratory function
• Patient Education : Teach patients about proper nutrition,
medication management, and blood glucose monitoring