A&E URINARY / DM/

ToxicologyEmergencies
TRAUMATIZED UTS
MOST COMMON

CASES:
Bleeding urinary

meatus
Testicular torsion
Cystitis
Hernia
Renal colic

Testicular Torsion
( twisting of the

supporting cord of
the testis

S/S scrotal edema,

fever, and abd. pain.

Pain, swelling, and

tenderness cannot
relieved by scrotal
elevation

Types of Hernia

Strangulated Hernia

blood supply is cut

off

2. Incarcerate Hernia
Hernia is trapped
outside
peritoneal cavity

Reducible Hernia Hernia moves back

into
peritoneal cavity

Cystitis
Recommendations:

 drink 8 to 10 glasses

of fluids /day
Women should wipe

from front to back

Urinate after

intercourse
Avoid vaginal

deodorants and
bubble bath.

DKA vs
HHNKA

Diabetes Mellitus

-disorder that causes

alterations in glucose
metabolism

Types of DM
Type I (DKA)

juvenile onset DM

insulin dependent DM

Type II (HHNK)

adult onset DM

non-insulin dependent
DM

Endocrine
emergencies
CAUSE OF DKA
initial presentation of
undiagnosed Type I DM
missed or reduced insulin
doses
illness (infection and stress
hormone excess)
stress
pregnancy

Pathophysiology

 beta cells inability to

produce insulin
hyperglycemia and
hyperosmolar state
hyperosmolarity causes

fluid shifting, fluid loss,

electrolyte shift and
dehydration
cells begin to break down

fats and protein to use for

fuel

 ketones are formed

leading to decreased
blood pH and bicarbonate
concentration causing
ketoacidosis

SIGNS AND
SYMPTOMS
dehydration
ketosis
metabolic acidosis
ketonuria

 weakness, anorexia,

vomiting, abdominal
pain
altered mental status
tachycardia, orthostatic

hypotension, poor skin

turgor, dry mucous
membranes
Kussmaul respiration
fruity sweet odor of

breath

EXAMS AND TESTS

Blood tests will be used

to check the levels of

 blood sugar,
potassium, sodium, and

other electrolytes.
Ketone levels and kidney

function markers along

with an arterial blood
gas
sample,
which
provides a blood acid
concentration.

Complications
Hypokalemia and

often, potassium
depletion
Cerebral edema

 Hyperglycemia
Ketoacidemia
Fluid and electrolyte

depletion
ESRD
Pulmonary edema
Myocardial Infarction

Treatment
Medical Management
Rapid fluid replacement

NSS then 0.45% NaCl

ABG monitoring

 bicarbonate
rapid acting insulin
correction of electrolyte

imbalance
correction of underlying

cause (e.g. infection)

Treatment
Nursing

Responsibilities
monitoring of serum

glucose at least every 2

hours

 glucose monitoring

should be done every 1-2

hours when receiving
insulin infusion
regular vital signs

monitoring
monitor cardiac,

pulmonary and neurologic

status
monitor laboratory values
provide client and family

support and education

compliance to

medications

 glucose monitoring and

regulation
eating schedules
diet
exercise
rest

HYPEROSMOLAR
HYPERGLYCEMIC
NON-KETOTIC
ACIDOSIS
(HHNK)

HHNK
Hyperosmolar

Hyperglycemic
nonketotic state is
one of two serious
metabolic
derangements
that
occurs
in
patients
with diabetes mellitus
and can be a lifethreatening
emergency.

Risk Factors

 Usually triggered by

something else, such

as an illness or
infection.
Kidney disorders
Heart failure
Insufficient amount

or missed dose of
insulin or antidiabetic
agents
Certain medications

(e.g., corticosteroids,
diuretics, beta
blockers)
Stress

 Drug abuse or

excessive
consumption of
alcohol
Overeating

(polyphagia)
Inactivity
Chronic illness
Recent surgery

Signs and Symptoms

Glucose (blood sugar)

level over 600

milligrams per
deciliter (mg/dL)

 Dry, parched mouth

Polydipsia (excessive

thirst)
Polyuria (increased

urination)
Warm, dry skin that

does not sweat

High fever (above

100.4 degrees
Fahrenheit, 38
degrees Celsius)
Low systolic blood

pressure (less than

100 mm/Hg)
Sleepiness

 Confusion
Vision loss
Hallucinations
Weakness on one side

of the body
Impaired speech

Treatment

 The treatment of

HHNS centers on
correcting the
patients dehydration,
hyperglycemia and
electrolyte
imbalances.
2. The patient may

receive intravenous
fluid to correct the
dehydration and
restore electrolytes.
3. Small doses of

intravenous insulin
may be given to treat
the hyperglycemia.

 4. Treatment of

precipitating causes
and complications

Prevention
1. Careful monitoring

of glucose levels
2. Ensuring adequate

hydration in patients
at risk of
3. Screening program.

Identify patients at
risk for HHNS.

 4. Avoiding excessive

amounts of alcohol.

DKA vs
HHNKA