Emergency Medicine
INSULIN SHOCK
Insulin shock is an acute condition from excessive insulin in the blood, resulting in low blood glucose levels (less than 50 mg per dL), convulsions, weakness, and coma.
Causes
Overdose of insulin
Skipped meal in an insulin-dependent diabetic
Strenuous exercise in an insulin-dependent diabetic
Symptoms
Tachycardia
Hunger
Increased irritability (nervousness)
Sweating and clammy (fainting)
Mental confusion and bizarre behavior
Seizures
Mild hypothermia
Coma
Treatment
If conscious, give fruit juice (orange juice).
If unconscious, IV 50% dextrose (50 mL at 10mL per min). Most patients regain consciousness in 5 to 10 minutes.
DIABETIC KETOACIDOSIS
Complication of diabetes mellitus resulting from extreme hyperglycemia. Plasma glucose may be in the range of 350 to 900 mg per dL.
Causes
Failure to take adequate amounts of insulin
First manifestation of an undiagnosed diabetic
Conditions that increase the patient’s requirements for insulin (infection, trauma)
Symptoms
Orthostatic hypotension with tachycardia and poor skin turgor (due to dehydration)
Abnormal mentation or unconscious
Kussmaul breathing—deep, rapid respiratory pattern (due to acidosis)
Fruity breath odor (due to acetone)
UA is strongly positive for both glucose and ketones.
Treatment
Insulin
IV fluids
In severe cases, give bicarbonate to correct pH.
SYNCOPE
Temporary inadequate supply of blood to the brain from a vasovagal response (fainting)
Causes
Fear/anxiety
Pain
Hot airless room
Symptoms
Prodrome (Prior to Fainting)
Lightheaded, yawning
Nausea
Patient complains of feeling hot.
Dimming of vision
Skin is cool, clammy, pale, and diaphoretic
Tachycardia
Unconsciousness
Slow weak pulse (bradycardia replaces tachycardia)
Abnormal movements may be noted during unconsciousness.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
