The prevalence of diseases transmitted by tick bite have increased in recent years, within the UK. And it is now recognised that there are 3 main infections
- Lyme Disease
- Tick-Bourne Encephalitis
- Babesia
Category: speciality
Covid-19 (Hyperglycaemia)
Both COVID-19 infection and treatment with dexamethasone impair glycemic control. So its important to monitor blood sugars and consider DKA & HHS in COVID-19 patients. Latest guidance from DIABETES-UK
GLUCOSE MONITORING
- Target glucose 6.0 -10.0 mmol/L (up to 12.0 mmol/L is acceptable)
Hypercalcaemia
90% of hypercalcaemia is due to either malignancy or hyperparathyroid.
Severity: Adjusted Calcium (Ca)
- Severe: >3.5mmol/l – URGENT treatment (risk of dysrhythmia)
- Moderate: 3.0-3.5mmol/l – PROMPT treatment (maybe well tolerated if chromic)
- Mild: <3.0mmol/l – doesn’t require urgent treatment and often asymptomatic
Hypokalaemia
Hypokalaemia (low potassium), is a common problem. It is found in 14% of outpatients and 20% of inpatients, however only 4-5% of those are of clinical significance.
Severity
- Severe: <2.5 mEq/l OR Symptomatic – Look for Hypomagnesaemia
- Moderate: 2.5-2.9 mEq/l (No or Minor symptoms)
- Mild: 3.0-3.4 mEq/l (Usually asymptomatic)
COVID-19 (DKA/HHS)
Experience is showing that those with diabetic patients with COVID-19 are more likely to develop DKA/HSS. However, treating them with the traditional large amount of fluid is detrimental to their chest, if they have Covid-19
Hence the following has been developed from the Guy & Thomas’ guidance – CLICK HERE
High Clinical Suspicion of Covid-19
- Clinical: Fever ≥37.8°C plus any of; cough, short of breath, myalgia, headache, sore throat
- CXR: consistent with Covid-19
Retrobulbar haemorrhage
What is retrobulbar haemorrhage?
- Rapidly progressing haemorrhage into the retrobulbar space which is rare but potentially sight threatening.
- Retrobulbar haemorrhage causes a rapid rise in intraorbital volume and pressure.
- If not treated it can quickly lead to retinal ischaemia and infarction resulting in permanent visual impairment or complete visual loss.
Hypocalcaemia
Hypocalcaemia can life threatening, due to arrhythmias and seizures.
Severity – Adjusted Calcium (Ca)
- Mild: >1.9mmol/l
- Severe: ≤1.9mmol/l OR Symptomatic
Hyponatraemia
Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior to treatment the following need to be considered and balanced.
- Symptoms Severity – these are not exclusive to hyponatraemia and may be due to other disease processes (esp. if the low sodium is long-term)
- Sodium Level – the sodium concentration doesn’t always correlate to the clinical picture, and is dependant on speed of change, and co-morbidities
- Rate of Drop – the faster sodium levels drop the more symptomatic the patient often is (i.e. with long term hyponatraema the patient may be profoundly hyponatraemic but asymptomatic)
- Co-morbidities – Increasing sodium too quickly risks osmotic demyelination. How well will the patient cope with treatment?
Emergency treatment (hypertonic saline) is generally indicated in those with Severe Symptoms ONLY
Hyperosmolar Hyperglycaemic State (HHS)
HHS (A.K.A. HONK) is a diabetic emergency, but unlike DKA we don’t always think about it.
Patients with HHS are often elderly with multiple co-morbidities, and they are always very sick.
Definition
- Hypovolaemia
- Hyperglycaemia – generally ≥30mmol/l
- High Osmolality – generally ≥320mosmol/kg (Calculation= 2[Na] + [Glucose] + [Urea])
- & NOT:
- Acidotic – pH >7.3, HCO3 >15mmol/l
- Ketotic – blood <3mmol/l, Urine <2+
Hypomagnesaemia
Classification
- Normal: 1.1-0.7
- Mild: 0.69-0.5
- Moderate: 0.49-0.4
- Severe: <0.4
Signs/Symps (normally <0.5)
- MSK: Muscle Twitch, Tremor, Tetany, Cramps
- CNS: Apathy, Depression, Hallucination, Agitation, Confusion, Seizure
- CVS: Tachycardia, Hypertension, Arrhythmia, Digoxin Toxicity
- BioChem: Hypokalaemia, Hypocalcaemia, Hypophosphataemia, Hyponatraemia
