ALOC with hypo/hyperglycemia
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Clare
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Patients with hypoglycaemia can have alterations in consciousness because the brain can only use glucose as "fuel" for want of a better term. If you do not put gas in your car it does not run, again for want of a better explanation; we did learn about the actual chemical reactions and such at uni but I can't remember them.
Alterations in consciousness with hyperglycaemia is a more complex problem and involves either DKA or non ketone hyperosmolar hyperglycaemic state but I have yet to see a patient even with severe DKA who is not awake.
DesertMedic66
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Had one yesterday. 550-600 pound female in DKA with a sugar of 440 mg/Dl.
Clare
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It can happen, and it's probably secondary to hyperosmolar diuresis or the acidosis interfering with normal cerebral cellular functioning (not sure which).
I also had to look up what mg/dl is in mmol/l - I remember seeing it referred to in the American Paramedic books but we don't use it.
mycrofft
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As Clare said, the brain is the body's top fuel dragster: give it "fuel" (usually glucose), oxygen and take away it's wastes ("exhaust"), and it is pretty happy. Starve it, let the wastes build up or cut off the oxygen and the reasoning goes, then it starts trying anything to get away from where it is (wandering, trying to drive or walk away from wherever the pt is), then it goes dormant.
The unreasoning/reactive tends to also start out as being agitated or "*****y"; since they may seem drunk and aggressive, some of them wind up in law enforcement booking departments where they hopefully are screened medically and observed periodically, and not whupped on.
The unreasoning/reactive tends to also start out as being agitated or "*****y"; since they may seem drunk and aggressive, some of them wind up in law enforcement booking departments where they hopefully are screened medically and observed periodically, and not whupped on.
DesertMedic66
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I was going to be nice and convert it for you but then we got a call so I decided to make you suffer :rofl:
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440 mg/dL isn't terribly high but it's plenty high enough.
DesertMedic66
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I didn't realize that it was high enough to cause DKA. Then again my knowledge on DKA is very limited (wasn't really covered in my EMT class).
Obstructions
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DKA doesn't necessarily mean that their BGL is through the roof. DKA disposes because of chronic (chronic meaning weeks or months) high BGL. So yes 400mg/dL can cause DKA, but I've heard of patients diagnosed with DKA after a few weeks of 300mg/dL in their veins.
For clarification.... high blood glucose does not "cause" DKA.
DKA is one of the more complex endocrine disorders, but basically the underlying pathophysiology is a lack or relative lack of insulin production.
So saying that chronically elevated blood glucose causes DKA is not an accurate statement. And in fact DKA can develop very quickly, even hours in a person who makes none of their own insulin.
So especially in Type 1 diabetic on an insulin pump if it malfunctions and they suddenly stop getting their basal insulin then they either need a new pump quickly or usually will his themselves some long acting insulin via injection.
Someone on insulin injections who runs out for even a day or two could go into DKA.
From a medicine standpoint it's one of the more interesting, and sometimes time/energy consuming acute illnesses to manage because of needing to understand electrolyte shifts, fluid balance, acid/base physiology, and figure out why they went into DKA in the first place.... noncompliance, infection, new diabetic, etc...
DKA is one of the more complex endocrine disorders, but basically the underlying pathophysiology is a lack or relative lack of insulin production.
So saying that chronically elevated blood glucose causes DKA is not an accurate statement. And in fact DKA can develop very quickly, even hours in a person who makes none of their own insulin.
So especially in Type 1 diabetic on an insulin pump if it malfunctions and they suddenly stop getting their basal insulin then they either need a new pump quickly or usually will his themselves some long acting insulin via injection.
Someone on insulin injections who runs out for even a day or two could go into DKA.
From a medicine standpoint it's one of the more interesting, and sometimes time/energy consuming acute illnesses to manage because of needing to understand electrolyte shifts, fluid balance, acid/base physiology, and figure out why they went into DKA in the first place.... noncompliance, infection, new diabetic, etc...
Aidey
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Your question was already answered.
Homework I take it? Better to look up the mechanisms yourself if you don't understand what was described here.
mycrofft
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Ketones are like black exhaust if you put motor oil in your gas tank. You body's not getting the pure fuel (glucose) it needs through the cellular walls so it's burning other stuff (sort of).
But we went through an evolution here recently about the brain being able to use ketones? Not sure if the osmolality works out right, though.
But we went through an evolution here recently about the brain being able to use ketones? Not sure if the osmolality works out right, though.
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Shishkabob
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No, the brain just is not efficient with using other forms of fuel.
Then you've not been doing this long enough.
Heck, 200 mg/dl can be seen in DKA. It's not so much the concentration of glucose, but the lack of the body utilizing it and relying on ketones instead.
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VirginiaEMT
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But a good answer indeed